PMID: 2123130Mar 1, 1990Paper

Opposite effects of propafenone and flecainide in a patient with reciprocating supraventricular tachycardia

Cardiologia : bollettino della Società italiana di cardiologia
A S MonteneroU Manzoli

Abstract

A 46 year-old woman with Wolff-Parkinson-White syndrome (postero-septal accessory pathway), symptomatic for recurrent episodes of nonsustained paroxismal supraventricular tachycardia (PSVT), was empirically treated with propafenone (600 mg/day). After a week of therapy the patient returned to the hospital after an episode of syncope. She referred a significant increase in duration and frequency of "palpitations". Under treatment with propafenone a sustained PSVT could be induced during transesophageal testing. During the electrophysiologic study performed off drugs, only a nonsustained PSVT could be induced. After flecainide infusion (1 mg/kg) anterograde block of the accessory pathway was observed and only few beats (less than 8) of PSVT could be induced. The patient was discharged on flecainide (200 mg/day) and 1 month later a transesophageal testing was repeated showing an anterograde block of the accessory pathway at a pacing cycle length of 500 ms; no arrhythmias were induced. The patient has been asymptomatic on chronic oral therapy with flecainide during a follow-up period of 8 months. This case shows that 2 1c class antiarrhythmic drugs may have opposite effects (proarrhythmic and antiarrhythmic). Failure, or even the p...Continue Reading

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