What is the use of Propafenone (Rythmol)

From the Guidelines

Propafenone (Rythmol) is used to treat supraventricular tachycardia, including atrial fibrillation and atrioventricular nodal reentrant tachycardia (AVNRT).

Uses of Propafenone

• Treatment of supraventricular tachycardia: Propafenone is effective in treating supraventricular tachycardia, including atrial fibrillation and AVNRT 1.
• Maintenance of sinus rhythm: Propafenone can be used to maintain sinus rhythm in patients with paroxysmal supraventricular tachycardia, including those with AVNRT 1.
• Prevention of postcardioversion atrial fibrillation: Propafenone can be used to prevent postcardioversion atrial fibrillation in patients with symptomatic atrial fibrillation 1.

Important Considerations

• Contraindications: Propafenone should not be used in patients with ischemic heart disease or left ventricular dysfunction due to the high risk of proarrhythmic effects 1.
• Dosing: The recommended dose of propafenone is 300 mg twice daily or 300 mg three times daily, with the higher dose associated with more frequent side effects 1.
• Monitoring: Close follow-up is necessary to avoid adverse effects due to the development of ischemia or heart failure 1.

Clinical Guidelines

• 2015 ACC/AHA/HRS guideline: Propafenone is recommended as a reasonable option for ongoing management in patients with AVNRT who are not candidates for, or prefer not to undergo, catheter ablation and in whom beta blockers, diltiazem, or verapamil are ineffective or contraindicated 1.
• 2011 ACCF/AHA/HRS focused update: Propafenone is recommended as a treatment option for patients with atrial fibrillation, including those with paroxysmal and persistent atrial fibrillation 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. – paroxysmal supraventricular tachycardia (PSVT) 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

The use of Propafenone (Rythmol) is for:

• Prolonging the time to recurrence of paroxysmal atrial fibrillation/flutter (PAF) and paroxysmal supraventricular tachycardia (PSVT) associated with disabling symptoms
• Treating documented ventricular arrhythmias, such as sustained ventricular tachycardia, that are life-threatening 2

From the Research

Use of Propafenone (Rythmol)

• Propafenone is a Class I antiarrhythmic agent with weak beta-adrenoceptor antagonist activity, used to treat arrhythmias 3.
• It is effective in suppressing premature ventricular complexes, couplets, and ventricular tachycardia, as well as atrial and AV nodal/junctional re-entrant tachycardias and Wolff-Parkinson-White tachycardias 3, 4, 5.
• Propafenone can be given both intravenously and orally, with dosage individualized due to dose-dependent pharmacokinetics and a wide range of clinically effective plasma concentrations 3.
• The drug has been shown to be effective in converting atrial fibrillation to sinus rhythm and preventing atrial fibrillation recurrences, with a high rate of efficacy (72-78% within 8 hours) when used as an oral loading dose 6.
• Propafenone also has a mild beta- and calcium channel-blocking activity, making it a useful first-line drug in the management of arrhythmias in patients with the Wolff-Parkinson-White syndrome 5.
• Additionally, propafenone has been found to have both Class Ic and Class II antiarrhythmic effects, with single oral doses causing clinically significant beta-blockade 7.

Therapeutic Uses

• Supraventricular arrhythmias, including atrial fibrillation, paroxysmal atrial fibrillation, and junctional reentrant tachycardias 6, 4, 5.
• Ventricular arrhythmias, including premature ventricular complexes, couplets, and ventricular tachycardia 3, 4.
• Wolff-Parkinson-White syndrome, particularly when there is a short anterograde refractory period of the accessory pathway 5.
• Paediatric supraventricular arrhythmias, including ectopic atrial and junctional tachycardias 5.

Important Considerations

• Propafenone may be associated with adverse effects, including proarrhythmic effects, and its usage must be based on a careful analysis of the risk-benefit ratio 3, 4.
• The drug should be used with caution in patients with underlying ventricular dysfunction or congestive heart failure, due to its potential negative inotropic effect 6, 4.
• Systematic exclusion of patients with left ventricular dysfunction or congestive heart failure is necessary when using propafenone as an oral loading dose 6.