[Therapy of ventricular tachyarrhythmias refractory to lidocaine with propafenone (author's transl)].
Lidocaine is most widely used for suppression of recurrent ventricular tachyarrhythmias by IV application. Advantages are good control and low incidence of signs of cardiac toxicity. Most important disadvantage is lack of possibility to continue therapy by oral administration. A serious problem is a high rate of non-responders, between 15 and 50% according to the literature. In our patients, rate of non-responders is about 25%. In these patients, other antiarrhythmic agents can be used, but therapeutic success is even more uncertain because of a higher rate of non-responders and adverse reactions in most instances. We administered Propafenone as drug of second choice in 30 patients with ventricular tachyarrhythmias refractory to Lidocaine. Initial bolus injection of 1-2 mg/kg body weight followed by drip infusion (0,2-0,5 mg/kg body weight/hr) or oral administration in those patients who responded to the initial bolus injection (83%). This regimen allowed sufficient control of the tachyarrhythmia in all patients of the responder group. Serious adverse reactions of cardiac origin were fall of blood pressure and exorbitant widening of QRS-complexes in three patients. A demonstration of a patient dying from pump failure with extremely widened QRS-complexes is given. Therefore we ask for caution regarding administration of Propafenone in patients with serious diffuse myocardial damage. Propafenone therefore seems to be well suited for therapy of ventricular tachyarrhythmias refractory to Lidocaine because of its low rate of non-responders and the possibility to continue treatment of oral administration of the drug.
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D004341:Drug Evaluation; D004351:Drug Resistance; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D007275:Injections, Intravenous; D008012:Lidocaine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011405:Propafenone; D011427:Propiophenones / Q000008:administration & dosage / Q000627:therapeutic use*; D013610:Tachycardia / Q000188:drug therapy*; D014693:Ventricular Fibrillation / Q000188:drug therapy
D011427:Propiophenones; D011405:Propafenone; D008012:Lidocaine
Therapie lidocain-refraktärer ventrikulärer Tachyarrhythmien mit Propafenon.