PURPOSE: Although the economic and mortality burden of atrial fibrillation (AF) is substantial, it remains unclear which treatment strategies for rate and rhythm control are most cost-effective. Consequently, economic factors can play an adjunctive role in guiding treatment selection. MATERIALS AND METHODS: We built a Markov chain Monte Carlo model using the Korean Health Insurance Review & Assessment Service database. Drugs for rate control and rhythm control in AF were analyzed. Cost-effective therapies were selected using a cost-effectiveness ratio, calculated by net cost and quality-adjusted life years (QALY). RESULTS: In the National Health Insurance Service data, 268149 patients with prevalent AF (age ≥18 years) were identified between January 1, 2013 and December 31, 2015. Among them, 212459 and 55690 patients were taking drugs for rate and rhythm control, respectively. Atenolol cost $714/QALY. Among the rate-control medications, the cost of propranolol was lowest at $487/QALY, while that of carvedilol was highest at $1363/QALY. Among the rhythm-control medications, the cost of pilsicainide was lowest at $638/QALY, while that of amiodarone was highest at $986/QALY. Flecainide and propafenone cost $834 and $830/QALY, respectively. The cost-effectiveness threshold of all drugs was lower than $30000/QALY. Compared with atenolol, the rate-control drugs propranolol, betaxolol, bevantolol, bisoprolol, diltiazem, and verapamil, as well as the rhythm-control drugs sotalol, pilsicainide, flecainide, propafenone, and dronedarone, showed better incremental cost-effectiveness ratios. CONCLUSION: Propranolol and pilsicainide appear to be cost-effective in patients with AF in Korea assuming that drug usage or compliance is the same.
Amiodarone ; Atenolol ; Atrial Fibrillation ; Betaxolol ; Bisoprolol ; Compliance ; Cost-Benefit Analysis ; Diltiazem ; Flecainide ; Humans ; Insurance, Health ; Korea ; Markov Chains ; Mortality ; National Health Programs ; Propafenone ; Propranolol ; Quality-Adjusted Life Years ; Sotalol ; Verapamil

In this study, we demonstrated the inhibitory effect of the Class Ic antiarrhythmic agent propafenone on voltage-dependent K⁺ (Kv) channels using freshly isolated coronary artery smooth muscle cells from rabbits. The Kv current amplitude was progressively inhibited by propafenone in a dose-dependent manner, with an apparent IC₅₀ value of 5.04±1.05 µM and a Hill coefficient of 0.78±0.06. The application of propafenone had no significant effect on the steady-state activation and inactivation curves, indicating that propafenone did not affect the voltage-sensitivity of Kv channels. The application of train pulses at frequencies of 1 or 2 Hz progressively increased the propafenone-induced inhibition of the Kv current. Furthermore, the inactivation recovery time constant was increased after the application of propafenone, suggesting that the inhibitory action of propafenone on Kv current is partially use-dependent. Pretreatment with Kv1.5, Kv2.1 or Kv7 inhibitor did not change the inhibitory effect of propafenone on the Kv current. Together, these results suggest that propafenone inhibits the vascular Kv channels in a dose- and use-dependent manner, regardless of Na⁺ channel inhibition.
Coronary Vessels ; Muscle, Smooth* ; Myocytes, Smooth Muscle* ; Propafenone* ; Rabbits

Concealed bypass tract (CBT) results from incomplete development of the atrioventricular (AV) annulus. CBT conducts only in a retrograde direction, and therefore does not cause pre-excitation on standard electrocardiograms. The most common tachycardia associated with CBT is an orthodromic atrioventricular reentrant tachycardia (AVRT): a pathway involving anterograde circuitry through the AV node and His Purkinje system and retrograde conduction over the accessory pathway. Orthodromic AVRT accounts for approximately 90%-95% cases of AVRT. Most incidences of CBT occur at the left free wall. Vagal maneuvers and/or intravenous (IV) adenosine are recommended for first line acute management of AVRT. However, pharmacological therapy with IV diltiazem, verapamil, or beta blockers can also be effective for acute treatment for orthodromic AVRT in patients who do not show pre-excitation on their resting ECG during sinus rhythm. The first-line ongoing therapy for AVRT is catheter ablation of CBT; when catheter ablation is not indicated or preferred, oral beta blockers, diltiazem, verapamil, flecainide, propafenone, or amiodarone are recommended.
Adenosine ; Amiodarone ; Atrioventricular Node ; Catheter Ablation ; Diltiazem ; Electrocardiography ; Flecainide ; Humans ; Incidence ; Propafenone ; Tachycardia ; Tachycardia, Supraventricular* ; Verapamil

BACKGROUND: Atrial fibrillation (AF) is one of the most common complications after cardiac surgery. Several therapeutic and preventive strategies have been introduced for postoperative AF, but the treatment and prophylaxis of AF remain controversial. We aimed to compare the efficacy of intravenous amiodarone and oral propafenone in the treatment of AF after coronary artery bypass grafting (CABG). METHODS: This was a randomized controlled trial performed in two hospitals in Shiraz, Iran from 2009 to 2012. We included all patients who underwent elective CABG and developed AF postoperatively. The patients were randomly assigned to receive propafenone or amiodarone. The duration of AF, the success rate of the treatment, the need for cardioversion, the frequency of repeated AF, and the need for repeating the treatment were compared. RESULTS: The duration of the first (p=0.361), second (p=0.832), and third (p=0.298) episodes of AF, the need for cardioversion (p=0.998), and the need to repeat the first and second doses of drugs (p=0.557, 0.699) were comparable between the study groups. Repeated AF was observed in 17 patients (30.9%) in the propafenone group and 23 patients (34.3%) in the amiodarone group (p=0.704). CONCLUSION: Oral propafenone and intravenous amiodarone are equally effective in the treatment and conversion of recent-onset AF after CABG.
Amiodarone* ; Atrial Fibrillation* ; Coronary Artery Bypass* ; Coronary Vessels* ; Electric Countershock ; Humans ; Iran ; Propafenone* ; Thoracic Surgery

Brugada syndrome is characterized by sudden cardiac death associated with ventricular tachyarrhythmia in patients without structural heart disease. We recently observed a case of concealed Brugada ECG pattern, which appeared after oral propafenone administration for atrial fibrillation. A 34-year-old male patient who experienced syncope was admitted to the emergency department with acute atrial fibrillation (AF). Three hundred milligrams of propafenone that were administered to convert AF to sinus rhythm unmasked the Brugada ECG pattern that had remained concealed. The patient showed a type 1 Brugada ECG pattern after taking propafenone.
Adult ; Atrial Fibrillation* ; Brugada Syndrome ; Death, Sudden, Cardiac ; Electrocardiography* ; Emergency Service, Hospital ; Heart Diseases ; Humans ; Male ; Propafenone* ; Syncope ; Tachycardia

OBJECTIVETo investigate the efficacy and safety of intravenous ibutilide for conversion of atrial fibrillation (AF) and flutter (AFL) to sinus rhythm.

METHODSNinety-nine consecutive patients aged 18-75 y with AF/AFL were included. The duration of arrhythmia was <90 d (1 h-90 d) and ventricular rate was >60 beats/min. Patients were assigned randomly into two groups: 49 patients in ibutilide group received ibutilide 1 mg, then repeated if AF/AFL was not converted after 10 min; 50 patients in propafenone group received propafenone 70 mg, then repeated if AF/AFL persisted after 10 min. Two drugs were diluted by 50 ml of 5% glucose and injected intravenously within 10 min.

RESULTSVentricular rates were decreased in both groups. AF/AFL were converted in 34 of 49 patients (69.4 % ) in ibutilide group and in 22 of 50 patients (44.0 %) in propafenone group (P <0.05). The converting time of ibutilide was significantly shorter than that of propafenone [(16.79 ± 12.31) min compared with (36.92 ± 11.38)min, P <0.01]. The most serious adverse effect of ibutilide was non-sustained monomorphic ventricular tachycardia (3/49,6.12 %). Transient hypotension and heart pause were the main adverse events in patients who received propafenone, acute left heart failure occurred in one patient of propafenone group.

CONCLUSIONIntravenous ibutilide is a safe and effective agent for cardioversion of recent-onset AF/AFL. Furthermore,strict processing under electrocardio-monitoring is important.

Adolescent ; Adult ; Aged ; Atrial Fibrillation ; drug therapy ; Atrial Flutter ; drug therapy ; Female ; Humans ; Male ; Middle Aged ; Propafenone ; therapeutic use ; Sulfonamides ; therapeutic use ; Treatment Outcome ; Young Adult

Brugada syndrome is a life threatening disease that is usually overlooked during emergency service admissions. It is characterized by typical electrocardiography resembling right bundle branch block, static or dynamic ST-segment elevation in leads V 1-3. There is familial tendency in some cases. A majority of patients have a structurally normal heart and are likely to remain asymptomatic, however they may present to emergency departments with syncope and various serious arrhythmias. Therefore it is crucially important for emergency medicine physicians not to omit this potential diagnosis. Herein we report a case with Brugada syndrome which was iatrogenically unmasked after propafenone administration for atrial fibrillation.
Arrhythmias, Cardiac ; Atrial Fibrillation ; Brugada Syndrome ; Bundle-Branch Block ; Electrocardiography ; Emergencies ; Emergency Medicine ; Heart ; Humans ; Propafenone ; Syncope

BACKGROUND/AIMS: Long-term antiarrhythmic drug therapy remains the principal approach for suppressing atrial fibrillation (AF) and maintaining sinus rhythm. In this study, we examined the differing electrophysiological effects of various antiarrhythmic drugs on the cardiac chamber and atrial selectivity in patients with AF. METHODS: We analyzed 134 patients (60.4 +/- 12.5 years, M:F = 1.14:1) who were administered a single antiarrhythmic agent for AF over 6 months: amiodarone (group A), flecainide (group F), or propafenone (group P). The P wave, QRS complex duration and dispersion, and QT interval and its dispersion were evaluated using a standard 12-lead electrocardiogram. RESULTS: There was no significant difference in age, gender ratio, or associated diseases among the three groups. In group A, Pmax, Pmin, P dispersion, QRSmax, QRSmin, and QRS dispersion were shorter than in groups F and P, whereas Pmax/QRSmax was the highest in group A (A = 1.2, F = 0.9, P = 1.0; p < 0.01). QTcmax and QTcmin were longer in group A, whereas QTc dispersion and the QT peak to end (A = 13.3 +/- 11.2, F = 30.7 +/- 24.9, P = 31.8 +/- 21.6; p < 0.01) were shorter in group A than in the other groups. CONCLUSIONS: Amiodarone had a weaker, but more selective, inhibitory effect on intra-atrial conduction, and inhibited ventricular repolarization more effectively and homogenously than flecainide or propafenone. These differing electrophysiological effects may contribute to the superior effectiveness and safety of amiodarone over flecainide or propafenone.
Amiodarone ; Anti-Arrhythmia Agents ; Atrial Fibrillation ; Electrophysiology ; Flecainide ; Humans ; Propafenone

Propafenone is a Class Ic antidysrhythmic agent, used in the management of atrial fibrillation. This is also a calcium channel and a weak beta blocker. The conventional therapy of hypotension induced by propafenone overdose includes fluid resuscitation followed by inotropic support. NaHCO3 is considered to be the treatment of choice. We report a case of successful insulin therapy for propafenone-induced hypotension unresponsive to NaHCO3. A 41-year-old woman with a prior medical history of atrial fibrillation presented to the ED after ingesting 4500 mg of propafenone, prescribed for her atrial fibrillation treatment. On initial examination, she was alert with O2 saturation of 96% and normal vital sign. Fifteen minutes later, her electrocardiogram revealed polymorphic ventricular tachycardia and then changed to ventricular fibrillation. When CPR was stopped, her BP was 70/40 mmHg, HR was 68 beats/min with wide QRS complex. Normal saline and inotropics were administered rapidly to improve hypotension. And we injected NaHCO3. Her blood pH was kept between 7.45 and 7.55. But, BP was not improved. Refractory to the conventional therapy for sodium channel blocker toxicity, we decided to try insulin treatment, considering properties of propafenonen having beta and calcium channel blocking effect. We administered short-acting insulin. Her blood glucose level was kept euglycemia by continuous 5% dextrose infusions and tried to keep serum potassium normal range. Thirty minutes after adminstering insulin, her SBP was checked at 100 mmHg. She was discharged 8 days post-ingestion without further complications. Insulin must be considered in severe hypotension induced by propafenone overdose unresponsive to other conventional therapy.
Adult ; Atrial Fibrillation ; Blood Glucose ; Calcium Channels ; Cardiopulmonary Resuscitation ; Electrocardiography ; Female ; Glucose ; Humans ; Hydrogen-Ion Concentration ; Hypotension ; Insulin ; Insulin, Short-Acting ; Potassium ; Propafenone ; Reference Values ; Resuscitation ; Shock ; Sodium ; Sodium Bicarbonate ; Sodium Channels ; Tachycardia, Ventricular ; Ventricular Fibrillation ; Vital Signs

The effects of the antiarrhythmic drug propafenone at c-type kv1.4 channels in Xenopus laevis oocytes were studied with the two-electrode voltage-clamp techinique. Defolliculated oocytes (stage V-VI) were injected with transcribed cRNAs of ferret Kv1.4 delta N channels. During recording, oocytes were continuously perfused with control solution or propafenone. Propafenone decreased the currents during voltage steps. The block was voltage-, use-, and concentration- dependent manners. The block was increased with positive going potentials. The voltage dependence of block could be fitted with the sum of monoexponential and a linear function. Propafenone accelerated the inactivate of current during the voltage step. The concentration of half-maximal block (IC(50)) was 121 micrometer/L. With high, normal, and low extracellular potassium concentrations, the changes of IC(50) value had no significant statistical differences. The block of propafenone was PH- dependent in high-, normal- and low- extracellular potassium concentrations. Acidification of the extracellular solution to PH 6.0 increased the IC50 values to 463 micrometer/L, alkalization to PH 8.0 reduced it to 58 micrometer/L. The results suggest that propafenone blocks the kv1.4 delta N channel in the open state and give some hints for an intracellular site of action.
Animals ; Anti-Arrhythmia Agents/*pharmacology ; Hydrogen-Ion Concentration ; Inhibitory Concentration 50 ; Kv1.4 Potassium Channel/*antagonists & inhibitors/metabolism ; Oocytes/drug effects/metabolism ; Patch-Clamp Techniques ; Potassium/*metabolism ; Potassium Channel Blockers/*pharmacology ; Propafenone/*pharmacology ; Xenopus laevis