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: Inglés
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.
REFERENCIAS (EN ESTE ARTÍCULO)
Evans W, Swann P: Lone atrial fibrillation. Br Heart J 1954-1 16: 189-194.
2. Kannel WB, Abbott RD, Savage DD, McNamara PM: Epidemiologic features of chronic atrial fibrillation. The Framingham Study. N Engl J Med 1982; 307-1018-1022.
3. Petersen P, Godtfredsen J: Atrial fibrillation-a review of course and prognosis. Acta Med Scand 1984; 216; 5-9.
4. Brand FN, Abott RD, Kannel WB, Wolf PA: Characteristics and prognosis of lone atrial. fibrillation. 30-Years follow-up in the Framingham Study. JAMA 1985; 254: 3449-3453.
5. Alpert JS, Petersen P, Godtfredsen J: Atrial fibrillation-natural history, complications and management. Ann Rev Med 1988, 39: 41-52.
6. Lown B, Amarasingham R, Neuman J: New method for terminating cardiac arrhythmias-use of synchronized capacitor discharge. JAMA 1962; 182: 548-555.
7. Goldman MJ: Quinidine treatment of auricular fibrillation. Am J Med Sci 1951; 186: 382-86.
8. Falk RH, Knowlton AA, Bemard SA, Gotlleb NE, Battinelli NJ: Digoxin for converting recent-onset atrial fibrillation to sinus rhvthm. A randomized, double blinded trial. Ann Intem Med 1987; 106: 503-506.
9. Falk RH, Leavitt JL: Digoxin for atrial fibrillation: a drug whose time has gone? Ann Intem Med 1991; 1 114: 573-575.
10. Lundstrom T, Ryden L: Ventricular rate control and exercise performance in chronic atrial fibrillation: effects of diltiazem and verapamil. J Am Coll Cardiol 1990; 16: 86-90.
11. Platia EV, Michelson EL, Porterfield JK, Das G: Esmolol versus verapamil in the acute treatment of atrial fibrillation or atrial flutter. Am J Cardiol 1989; 63: 925-929.
12. Kochiadakis GE, Igoumenidis NE, Solomou MD, Parthenakis FI, Christakin-Hampsis, Chlouverakis GI, et al: Conversion of atrial fibrillation to sinus rhythm using intravenous procainamide infusion. Cardiovasc Drugs Ther. 1998; 12: 75-81.
13. Deano DA, Wu D, Mautner RK, Sherman RH, Ehsani AE, Rosen KM: The antiarrhythmic efficacy of intravenous therapy with disopiramyde phosphate. Chest 1977; 71: 597-606.
14. Crijns HJ, Van Wijk LM, Van Gllst WH, Kingma JH, Van Gelder IC, Lle KI: Acute conversion of atrial fibrillation to sinus rhythm: clinical efficacy of flecainide acetate: Comparison of two regimens. Eur Heart J 1988; 9-634-638.
15. Donovan KD, Dobb GJ, Coombs LJ, Lee K-Y, Weekes JN, Murdock ChJ, et al: Efficacy of flecainide for the reversion of acute onset atrial fibrillation. Am J Cardiol 1992; 70: 50A-55A.
16. Faniel R, Schoenfeld P: Efficacy of intravenous amiodarone in converting rapid atrial fibrillation and flutter to sinus rhythm in intensive care patients. Eur Heart J 1983, 4: 180-185.
17. Kerin NZ, Faitel K, Nouni M: The efficacy of intravenous amiodarone for the conversion of chronic atrial fibrillation. Amiodarone versus quinidine for cardioversion of atrial fibrillation. Arch Intem Med 1996; 156: 49-53.
Kochiadakis GE, Igoumenidis NE, Solomou MC, Kaleboubas MD, Chlouverakis GI, Vardas PE: Efficacy of amiodarone for the termination of persistent atrial fibrillation. Am J Cardiol 1999; 83-58-61.
19. Camm J. Classification of atrial fibrillation. Am J Cardiol 1998, 82(8A): 18N-28N.
20. Levy S: Epidemiology and classification of atrial fibrillation. J Cardiovasc Electrophysiol 1998; 8 (suppl): S78-S82.
21. Sung RJ, Tam HI, Karagounis L, Hanyok JJ, Falk R, Platia E, et al: Intravenous sotalol for the termination of supraventricular tachycardia and atrial fibrillation and flutter. A multicenter randomized, double blind, placebo controlled study. Sotalol Multicenter Study Group. Am Heart J 1995; 129: 739-748.
22. Vos MA, Golitsyn SR, Stangl K, Ruda MY, Van Wijk LV, Harry JD, et al: Superiority of ibutilide (a new class III agent) over DL-Sotalol in converting atrial fibrillation and atrial flutter. The Ibutilide/Sotalol Comparates Study Group. Heart 1998; 79: 568-575.
23. Kingma JH, Suttorp MJ: Acute pharmacologic conversion of atrial fibrillation and flutter: the role of flecainide, propafenone and verapamil. Am J Cardiol 1992; 70:
24. Cointe R, Metge M, Bru P, Vrancea F, Gerard R, Paganelli F, et al: Intravenous and oral propafenone in the treatment and prevention of paroxysmal atrial fibrillation. Ann Cardiol Angeiol 1993; 42: 223-227.
Minutiello L: Efficacy of intravenous propafenone in the management of atrial flutter and fibrillation of recent onset. Minerva Cardioangiol 1994; 42: 119-122.
Bellandi F, Cantini F, Pedone T, Palebetti R, Mamosbmoosh M, Dabizzi RP. Effectiveness of intravenous propafenone for conversion of recent-onset atrial fibrillation: a placebo-controlled study. Clin Cardiol 1995; 18: 631-634.
Bellandi F, Dabizzi RP, Cantini F, Natale MD, Niccoll L: Intravenous propafenone: efficacy and safety in the conversion to sinus rhythm of recent onset atrial fibrillation: a single-blind placebo-controlled study. Cardiovasc Drugs Ther 1996; 10: 153-157.
Fresco C, Proclemer A, Pavan A, Bula G, Vicentini A, Pavan D, et al: Intravenous propafenone in paroxysmal atrial fibrillation: a randomized, placebo-controlled, double-blind, multicenter clinical trial. Paroxysmal Atrial Fibrillation Itallan Trial (PAFIT)-2 Investigators. Clin Cardiol 1996; 19: 409-412.
29. Stroobandt R, Stiels B, Hoebretchts R: Propafenone for conversion and prophylaxis of atrial fibrillation. Propafenone Atrial Fibrillation Trial Investigators. Am J Cardiol 1997; 79: 418-423.
Remold SC, Maisel WH, Antman EM: Propafenone for the treatment of supraventricular tachycardia and atrial fibrillation: a meta-analysis. Am J Cardiol 1998; 82:
Ganau G, Lenzi T: Intravenous propafenone for converting recent onset atrial fibrillation in emergency departments: a randomized placebo-controlled multicenter trial. FAPS Investigators Study Group. J Emerg Med 1998; 16: 383-387.
Ludmer PL, McGowan NE, Antman EM, Friedman PL: Efficacy of propafenone in Wolff-Parkinson-White syndrome: electrophysiologic finding and long-term follow-up. J Am Coll Cardiol 1987; 9:1357-1363.
Dubuc M, Kus T, Campa MA, Lambert C, Rosengarten M, Shenasa M: Electrophysiologic effects of intravenous propafenone in Wolff-Parkinson-White syndrome. Am Heart J 1989; 1117: 370-376.
Boahene KA, Klein GJ, Yee R, Sharma AD, Fujimura O: Termination of acute atrial fibrillation in the Wolff-Parkinson-White syndrome by procainamide and propafenone: importance of atrial fibrillatoy cycle length. J Am Coll Cardiol 1990; 16: 1408-1414.
Santinelli V, Turco P, De Paola M, Smimmo D, Giasi M, Santinelli C, et al: Propafenone in Wolff-Parkinson-White syndrome at risk. Cardiovasc Drugs Ther 1990; 4: 681-685.
O’Nunain S, Garrat CJ, Linker NJ, Gill J, Ward DE, Camm AJ: A comparison of intravenous propafenone and flecainide in the treatment of tachycardia associated with the Wolff-Parkinson-White syndrome. PACE 1991; 14 (Pt 2): 2028-2034.
Maia IG,, Cruz Filho F, Fagundes ML, Loyola LH, Pimenta J, Lorga AM: Acute effects of propafenone in patients with ventricular pre-excitation. Arq Bras Cardiol 1993; 61-23-26.
Verhorst PM, Kamp O, Welllng RC, Van Ecnige MJ, Visser CA: Transesophageal echocardiographic predictors for maintenance of sinus rhythm after electrical cardioversion of atrial fibrillation. Am J Cardiol 1997; 79: 1355-1359.
Van Gelder IC, Crijns J, Tieleman RG, Brugemann J, De Kam PJ, Gosselink AT, et al: Chronic atrial fibrillation. Success of serial cardioversion therapy and safety of oral anticoagulation. Arch Intern Med 1996; 156: 2585-2592.
Gentili C, Giordano F, Alois A, Massa E, Blanconi L: Efficacy of intravenous propafenone in acute atrial fibrillation complicating open-heart surgery. Am Heart J 1992; 123: 1225-1228.
Velázquez RE, de los Ríos O, Rendón Y: Cardioversión farmacológica de fibrilación auricular a ritmo sinusal con amiodarona versus propafenona endovenosa. (Abstract) Arch Inst Cardiol Méx 1991; 61:5.
Wijffels MC, Dorland R, Allessie MA: Pharmacologic cardioversion of chronic atrial fibrilation in the goat by class IA, IC and III drugs: a comparison between hidroquinidine, cibezoline, flecainide, and d-sotalol. J- Cardiovasc Electrophysiol 1999; 10: 178-193.
Texto completo
Cómo citar este artículo