Propafenone effect on inotropic myocardial function in patients with recurrent atral fibrillation

Aim. To study the effects of three-month propafenone antiarrhythmic therapy (daily dose 450 mg) on inotropic myocardial function in patients with recurrent atrial fibrillation (AF). Material and methods. The study included 18 (100%) patients aged 39-59 years (mean age 51.7±6.7 years), receiving propafenone (450 mg/d) for 3 months, to prevent recurrent AF. To assess antiarrhythmic therapy effects on inotropic myocardial function, all participants underwent balanced radionuclide ventriculography at baseline; in patients with maintained sinus rhythm, it was repeated after 3 months of treatment. Results. In first 3 days after restoring sinus rhythm in recurrent AF patients, diastolic function dynamics was observed: significant reduction in 1/3 diastole filling and peak filling velocity. After 3 months of propafenone treatment, left ventricular (LF) 1/3 diastole filling (p<0.05), as well as LV and right ventricular (RV) filling peak velocity (p<0.05), significantly increased. Ejection fraction, systolic and volumic parameters of LV and RV stayed within the normal range and did not change significantly. After 3-month propafenone therapy, recurrent AF patients demonstrated significant increase in atrial input into LV diastole – from 17.1±5.7% to 22.1±6.5%, and RV diastole – from 17.3±5.1% to 21.1±6.2% (р<0.05). Conclusion. Propafenone therapy (450 mg/d) facilitated 3-month sinus rhythm maintenance in 77% patients with recurrent AF. The therapy did not affect LF and RV inotropic myocardial function. Maintaining sinus rhythm for 3 moths facilitated normalization of atrial contractility and ventricular diastolic dysfunction improvement. 

1. Аржакова Г.С., Фомина И.Г., Ветлужский А.В. Современные принципы лечения мерцательной аритмии с позиции классификации «Сицилианский гамбит». Кардиоваск тер профил 2002; 1: 68-75.

2. Миллер О.Н., Пономаренко С.В. Диагностика и лечение наджелудочковых тахиаритмий. Пропафенон: основы клинической фармакологии и опыт применения при фибрилляции предсердий. Учебное пособие для врачей. Новосибирск 2003; 31 с.

3. Татарский Б.А. Протекторный эффект пропафенона при пароксизмальных реципрокных атриовентрикулярных тахикардиях. РКЖ 2004; 1: 45-53.

4. Dogan A, Ergene O, Nazli C, et al. Efficacy of propafenone for maintaining sinus rhythm in patients with recent onset or persistent atrial fibrillation after conversion: a randomized, placebo-controlled study. Acta Cardiol 2004; 59(3): 255-61.

5. Falk RH. Atrial fibrillation. In book: Girdiac Arrhythmia. Ed. Podnd PJ, Kowey PR. Williams&Wilkins. Baltimore 1995; 803-28.

6. Jenkins LS, Brodsky M, Schron E, et al. Quality of life in atrial fibrillation: the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. Am Heart J 2005; 149(1): 112-20.

7. Kochiadakis GE, Igoumenidis NE, Hamilos MI, et al. Longterm maintenance of normal sinus rhythm in patients with current symptomatic atrial fibrillation: amiodarone vs propafenone, both in low doses. Chest 2004; 125(2): 377-83.

8. Miller JM, Zipes DP. Management of the patient with cardiac arrhythmias. In: Brounwald E, Zipes DP, Libby P. Heart Disease. Philadelphia WB Saunders 2001; 659-700.

9. Quiniou G, Chevalier JM, Barbou F, et al. Tachycardia-induced cardiomyopathy, unusual and reversible cause of left ventricular dysfunction: report of 9 cases. Ann Cardiol Angeiol (Paris) 2000; 49(5): 301-8.

10. Wyse DG, Waldo AL, DiMarco JP, et al. A comparison of rate and rhythm control in patients with recurrent persistent atrial fibrillation. The Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Investigators. N Engl J Med 2002; 347: 1825-33.

11. Wyse DG. The AFFIRM trial: main trial and substudies – what can we expect? J Inter Cardiac Electrophys 2000; 4: 171-6.