Efficacy of propafenone in Wolff-Parkinson-White syndrome: electrophysiologic findings and long-term follow-up
Open accessAbstract
The efficacy and safety of intravenous propafenone was studied in 10 patients with Wolff-Parkinson-White syndrome and in 2 patients with a concealed accessory pathway. During electrophysiologic study, the effect of propafenone on the effective refractory period of the accessory pathway was determined, as well as its effect during orthodromic atrioventricular (AV) reentrant tachycardia and atrial fibrillation. Propafenone caused significant increases in the accessory pathway refractory period, both in the anterograde direction (290 +/- 19 versus 474 +/- 50 ms, p less than 0.05) and in the retrograde direction (238 +/- 15 versus 408 +/- 44 ms, p less than 0.05). Complete anterograde accessory pathway conduction block occurred in four patients. Sustained AV reentrant tachycardia was inducible in 11 patients before administration of propafenone. Drug infusion during AV reentrant tachycardia promptly terminated arrhythmia in 10 of these 11 patients and caused slowing of AV reentrant tachycardia in the remaining patient. Before propafenone, sustained atrial fibrillation was inducible in six patients and nonsustained atrial fibrillation in four patients. After propafenone, no patient had inducible sustained atrial fibrillation. Furthermore, propafenone caused a marked decrease in peak ventricular rate during atrial fibrillation. Eight patients have been treated with oral propafenone and followed up for 12 +/- 2 months. All have remained virtually free of recurrent arrhythmia and none has developed significant side effects. Propafenone is a very promising agent for emergency intravenous therapy as well as long-term oral therapy in patients with Wolff-Parkinson-White syndrome.
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In atrial fibrillation, ibutilide, procainamide, propafenone and flecainide act mainly to prevent fast conduction through the accessory pathway.
“In AF, antiarrhythmic drugs as ibutilide, procainamide, propafenone or flecainide, which act mainly to prevent fast conduction through the pathway, are preferable, even if they do not restore sinus rhythm.83,310,311”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [310]
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Katritsis, D. G., Boriani, G., Cosio, F. G., Hindricks, G., Jaïs, P., Josephson, M. E., Keegan, R., Kim, Y.-H., Knight, B. P., Kuck, K.-H., et al. (2017) · Europace · doi:10.1093/europace/euw301 · Cited by 188 · see citing works
- Authors
- Ludmer, P. L., McGowan, N. E., Antman, E. M., & Friedman, P. L.
- Corresponding author
- Friedman, Peter L.
- ORCID
- Antman, Elliott M.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 1987-06
- Volume
- 9
- Issue
- 6
- Pages
- 1357-1363
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2012382461
- Cited by
- 88
- References
- 25
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 2 · 2023: 3 · 2022: 4 · 2021: 5 · 2020: 1 · 2019: 2 · 2016: 2 · 2012: 1
- FWCI
- 8.80
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Keywords
- propafenone, Wolff-Parkinson-White syndrome, accessory pathway, effective refractory period, orthodromic atrioventricular reentrant tachycardia, atrial fibrillation, intravenous antiarrhythmic therapy, oral antiarrhythmic therapy, long-term follow-up, concealed accessory pathway
- MeSH terms
- Adolescent, Adult, Atrial Fibrillation, Clinical Trials as Topic, Electrophysiology, Female, Follow-Up Studies, Heart Conduction System, Humans, Male, Middle Aged, Neural Pathways, Propafenone, Refractory Period, Electrophysiological, Tachycardia, Atrioventricular Nodal Reentry, Time Factors, Wolff-Parkinson-White Syndrome
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