title: Oral loading with propafenone for conversion of recent-onset atrial fibrillation: a review on in-hospital treatment.
abstract: Atrial fibrillation (AF) is a very common arrhythmia. In order to treat acute AF rapidly, effective drug regimens are required. Propafenone is a class IC antiarrhythmic agent that is suitable for oral loading as it reaches peak plasma concentrations within 2 to 4 hours of administration. The use of propafenone loading in patients with AF must be based on appropriate patient selection in view of the negative inotropic effect and the potential proarrhythmic effects of the drug. A series of controlled trials in patients with recent-onset AF without heart failure who were hospitalised with enforced bed rest has shown that orally loaded propafenone (450 to 600 mg as single dose) exerts a relatively quick effect (within 3 to 4 hours) and a high rate of efficacy (72 to 78% within 8 hours). A potentially harmful effect of class IC agents is the risk of transforming AF into atrial flutter (3.5 to 5% of patients). However, atrial flutter with 1 : 1 atrioventricular response was observed in only two of 709 patients receiving propafenone (0.3% incidence). Nevertheless, the potential negative inotropic effect of propafenone demands careful patient selection, with systematic exclusion of patients with left ventricular dysfunction or congestive heart failure. Oral loading with propafenone can be considered as an episodic treatment in patients with AF recurrences, as has been proposed for other drugs in the past. However, the safety of oral loading with propafenone as an outpatient treatment in appropriately selected patients has to be assessed by appropriately designed prospective studies.
authors.affiliation: Institute of Cardiology, University of Bologna, Policlinico S. Orsola, Via Massarenti 9, 40138 Bologna, Italy. cardio1@almadns.unibo.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
authors.forename: Cristian
authors.initials: C
authors.lastname: Martignani
authors.forename: Mauro
authors.initials: M
authors.lastname: Biffi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Capucci
authors.forename: Angelo
authors.initials: A
authors.lastname: Branzi
mesh_terms: D000284:Administration, Oral; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D002986:Clinical Trials as Topic; D006339:Heart Rate / Q000187:drug effects; D006760:Hospitalization; D006801:Humans; D018579:Patient Selection; D011405:Propafenone / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D013997:Time Factors
chemical_list: D000889:Anti-Arrhythmia Agents; D011405:Propafenone