Document Detail

Atrial tachycardia with 1:1 atrioventricular conduction precipitated by propafenone.
MedLine Citation:
PMID:  19934146     Owner:  NLM     Status:  MEDLINE    
A 58-year-old man presented to the emergency department with sudden onset rapid palpitations and significant presyncope while walking on the flat. The previous day he had undergone DC cardioversion for atrial fibrillation (AF) which had been initially successful. However, 6 h after cardioversion he was aware of intermittently raised but regular heart rates. On arrival at the emergency department (ED) he was well with no haemodynamic compromise. The ECG showed an atrial tachycardia instead of AF. Medications consisted of propafenone 300 mg twice daily, bisoprolol 5 mg at night and warfarin. Bisoprolol was increased to 5 mg twice daily and he was discharged with a plan for outpatient ablation. He collapsed in the hospital car park with rapid palpitations, chest tightness and vagal symptoms. On return to the ED he was hypotensive with a heart rate of 200 bpm. The ECG showed 1:1 atrioventricular conduction (AV) of the atrial tachycardia which promptly improved after administering intravenous atenolol. Class 1c antiarrhythmic agents such as propafenone can precipitate 1:1 AV conduction of atrial tachycardias resulting in dangerous exacerbations of ventricular rate or even malignant tachyarrhythmias. It is therefore essential that concomitant AV blocking agents are used both prophylactically or acutely in suspected cases.
A Khavandi; S K Walker
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Emergency medicine journal : EMJ     Volume:  26     ISSN:  1472-0213     ISO Abbreviation:  Emerg Med J     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-11-25     Completed Date:  2010-01-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100963089     Medline TA:  Emerg Med J     Country:  England    
Other Details:
Languages:  eng     Pagination:  904-5     Citation Subset:  IM    
Department of Cardiology, Bristol Heart Institute, Bristol Royal Infirmary, Bristol, UK.
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MeSH Terms
Anti-Arrhythmia Agents / adverse effects*
Atrial Fibrillation / therapy*
Bundle of His / physiopathology
Electric Countershock
Middle Aged
Propafenone / adverse effects*
Tachycardia, Atrioventricular Nodal Reentry / chemically induced*,  physiopathology
Reg. No./Substance:
0/Anti-Arrhythmia Agents; 54063-53-5/Propafenone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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