Accelerated AV nodal conduction with use of procainamide in atrial fibrillation.
BACKGROUND
Atrial fibrillation is a common dysrhythmia seen in the emergency department (ED). Chemical or electrical cardioversion may be performed on patients who have had atrial fibrillation for < 48 h duration and who are at low risk for thromboembolic events. Multiple studies suggest that intravenous procainamide is an appropriate agent in the treatment of acute atrial fibrillation due to its relatively low risk profile and high conversion rate.


OBJECTIVE
A case is presented that demonstrates an adverse reaction to the use of intravenous procainamide for chemical cardioversion of atrial fibrillation in an otherwise hemodynamically stable patient.


METHODS
We report a case of lone paroxysmal atrial fibrillation in a patient with a structurally normal heart who suffered paradoxical accelerated atrioventricular nodal conduction and secondary hypotension in response to procainamide administration.


CONCLUSIONS
When administering procainamide for chemical cardioversion of atrial fibrillation, a low threshold should be maintained for administration of a complementary rate-controlling agent, and facilities for immediate electrical cardioversion always must be available.
Perkins
Alisha
A
Department of Emergency Medicine, Division of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Marill
Keith
K
D000889:Anti-Arrhythmia Agents / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D001283:Atrioventricular Node / Q000187:drug effects / Q000503:physiopathology; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D011342:Procainamide / Q000009:adverse effects*; D013610:Tachycardia / Q000139:chemically induced*
D000889:Anti-Arrhythmia Agents; D011342:Procainamide