From the Guidelines
Propafenone is recommended for the treatment of atrial fibrillation, particularly for paroxysmal atrial fibrillation in patients without structural heart disease, at an initial dose of 150-300 mg orally three times daily, with maintenance doses ranging from 450-900 mg daily divided into three doses. For atrial fibrillation, propafenone works by blocking sodium channels, which slows conduction and prolongs refractoriness in cardiac tissue, thereby helping to maintain sinus rhythm and prevent tachycardia-induced cardiomyopathy 1.
Key Considerations
- Propafenone should be avoided in patients with heart failure, coronary artery disease, or significantly reduced left ventricular function as it has negative inotropic effects that can worsen these conditions 1.
- Common side effects include dizziness, blurred vision, altered taste, nausea, and constipation.
- Patients should be monitored with ECGs regularly, especially when initiating therapy, as propafenone can paradoxically worsen arrhythmias in some cases or convert atrial fibrillation to atrial flutter with rapid ventricular response 1.
Dosage and Administration
- The typical dosage of propafenone for maintaining sinus rhythm in patients with atrial fibrillation is 450-900 mg daily, divided into three doses 1.
- The choice of antiarrhythmic drug therapy, including propafenone, should be individualized based on the patient's specific condition, including the presence of structural heart disease, coronary artery disease, or heart failure 1.
Monitoring and Follow-up
- Regular ECG monitoring is recommended, especially when initiating therapy, to detect potential proarrhythmic effects or worsening of arrhythmias 1.
- Patients should be alerted to the potential significance of symptoms such as syncope, angina pectoris, or dyspnea, and warned about the use of non-cardiac drugs that can prolong the QT interval 1.
From the FDA Drug Label
In patients without structural heart disease, propafenone is indicated to prolong the time to recurrence of – paroxysmal atrial fibrillation/flutter (PAF) associated with disabling symptoms. Propafenone HCl is also indicated for the treatment of – documented ventricular arrhythmias, such as sustained ventricular tachycardia, that, in the judgment of the physician, are life-threatening Propafenone HCl should not be used to control ventricular rate during atrial fibrillation.
The recommended treatment for atrial fibrillation using Propafenone is to prolong the time to recurrence of paroxysmal atrial fibrillation/flutter (PAF) associated with disabling symptoms. For ventricular tachycardia, Propafenone is indicated for the treatment of documented ventricular arrhythmias, such as sustained ventricular tachycardia, that are life-threatening 2.
From the Research
Treatment of Atrial Fibrillation and Ventricular Tachycardia using Propafenone
- Propafenone is a Class I antiarrhythmic agent with weak beta-adrenoceptor antagonist activity, effective in treating atrial fibrillation and ventricular tachycardia 3, 4, 5, 6, 7.
- The recommended dosage of propafenone must be individualized due to dose-dependent pharmacokinetics and a wide range of clinically effective plasma concentrations 3, 6.
- Propafenone has been shown to be effective in:
- Converting atrial fibrillation to sinus rhythm 4, 5, 7
- Preventing atrial fibrillation recurrences 4, 5, 7
- Suppressing ventricular premature complexes and nonsustained ventricular tachycardias 3, 4, 6
- Treating malignant ventricular arrhythmias, such as ventricular fibrillation and sustained ventricular tachycardia 6
- The efficacy of propafenone in treating atrial fibrillation and ventricular tachycardia has been demonstrated in several clinical studies, with response rates ranging from 38% to 77% 3, 4, 5, 6, 7.
- Propafenone has a favorable risk-benefit profile, with common side effects including neurological and gastrointestinal symptoms, which are generally well-tolerated and resolve with continued therapy or dosage reduction 3, 4, 6.
- However, propafenone may also exert proarrhythmic effects, and its use should be carefully considered in patients with underlying ventricular dysfunction or other risk factors for arrhythmias 3, 4, 6.