2000, Número 2
Arch Cardiol Mex 2000; 70 (2)
Cardioversión farmacológica con propafenona intravenosa en fibrilación auricular
Velázquez RE, Cancino RC, Arias ES, Rangel RJ, Hernández ME, Uribe MA
Idioma: Español
Referencias bibliográficas: 44
Paginas: 160-166
Archivo PDF: 151.73 Kb.
RESUMEN
La eficacia y seguridad de propafenona por vía intravenosa para la cardioversión de fibrilación auricular a ritmo sinusal de reciente inicio y/o crónica fueron evaluadas en 46 pacientes, 40 con fibrilación auricular con o sin cardiopatía estructural (edad media 63 ± 14 años) y 6 pacientes con fibrilación auricular relacionada a síndrome de Wolff-Parkinson-White. (edad media 34.8 ±13 años). El tratamiento con propafenona intravenosa fue administrado a razón de 2 mg/kg en 15 minutos con monitoreo electrocardiográfico continuo. En 28 de 32 (87.5%) pacientes con fibritación auricular paroxística y/o de reciente inicio se restauró un ritmo sinusal estable dentro de la primera hora (media 17 ± 11 minutos) y en sólo 3 de 8 (37.5%) de los casos con fibrilación auricular crónica (p‹0.05). La conversión a ritmo sinusal se obtuvo en 5 de 6 (83.3%) pacientes con fibrilación auricular relacionada con preexcitación ventricular, tiempo medio de 21 ± 12 minutos. La propafenona tuvo un efecto adicional al reducir la frecuencia ventricular media 141 ± 21 a 102 ± 15 latidos por minuto (p ‹ 0.05) y una prolongación del intervalo R-R preexcitado más corto, media 231.6 ± 27.8 a 355.8 ± 37.2 milisegundos (p ‹ 0.001) en los casos con preexcitación ventricular. Un paciente con valvulopatía mitral reumática y FE 40% desarrolló trastornos transitorios de conducción intraventricular, mareo e hipotensión arterial. La propafenona intravenosa es un agente efectivo y seguro para la cardioversión a ritmo sinusal de la fibrilación auricular paroxística y/o de reciente inicio y tiene una utilidad más limitada en la fibrilación auricular permanente.
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