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Article: Control of paroxysmal atrial fibrillation recurrence using combined administration of propafenone and quinidine

TitleControl of paroxysmal atrial fibrillation recurrence using combined administration of propafenone and quinidine
Authors
Issue Date2000
PublisherExcerpta Medica, Inc. The Journal's web site is located at http://www.ajconline.org/
Citation
American Journal Of Cardiology, 2000, v. 86 n. 12, p. 1327-1332 How to Cite?
AbstractThe frequent recurrence of paroxysmal atrial fibrillation (PAF) despite the use of standard antiarrhythmic agents prompted the use of new therapeutic approaches. There are few data on systematic assessment of PAF control with stepwise dose escalation and the use of a drug combination. Low-dose quinidine may promote the efficacy of propafenone by inhibiting its degradation through the cytochrome P450 pathway (CYP2D6). We prescribed propafenone 300 to 450 mg/day to 60 patients with PAF for 8 weeks, and 62% were symptomatically controlled. The 19 refractory patients were randomized in a double-blinded fashion to receive either a higher dose of propafenone (450 to 675 mg/day) or the standard dose of propafenone with low-dose quinidine 150 mg/day, each for an 8-week study period, and subsequently crossed over to the alternative treatment. The resulting serum propafenone concentrations were 259 ± 208 and 336 ± 237 mg/day (p >0.5), respectively. Both treatment arms prolonged the time to the first symptomatic atrial fibrillation (AF) recurrence and the interval between attacks, and AF was controlled in 37% of patients. However, the higher dose of propafenone was associated with gastrointestinal side effects not present with the low-dose quinidine combination. Of the 10 refractory patients, 7 were further controlled with a standard dose of propafenone plus quinidine (600 mg/day). Overall, control of PAF was achieved in 85% of patients at the end of 8 months; adverse effects necessitating withdrawal were observed in 6%, and uncontrolled AF in 5% of patients. There was no difference in the mean AF rate during recurrences in all phases, and ventricular proarrhythmia was not seen. This study documents the role of stepwise antiarrhythmic treatment of PAF. The use of a standard dose of propafenone, followed by low-dose quinidine combination to reduce propafenone degradation, and the combined standard dose of propafenone and quinidine may be used to maximize efficacy and tolerability. (C) 2000 by Excerpta Medica, Inc.
Persistent Identifierhttp://hdl.handle.net/10722/162454
ISSN
2015 Impact Factor: 3.154
2015 SCImago Journal Rankings: 2.063
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorLau, CPen_US
dc.contributor.authorChow, MSSen_US
dc.contributor.authorTse, HFen_US
dc.contributor.authorTang, MOen_US
dc.contributor.authorFan, Cen_US
dc.date.accessioned2012-09-05T05:20:05Z-
dc.date.available2012-09-05T05:20:05Z-
dc.date.issued2000en_US
dc.identifier.citationAmerican Journal Of Cardiology, 2000, v. 86 n. 12, p. 1327-1332en_US
dc.identifier.issn0002-9149en_US
dc.identifier.urihttp://hdl.handle.net/10722/162454-
dc.description.abstractThe frequent recurrence of paroxysmal atrial fibrillation (PAF) despite the use of standard antiarrhythmic agents prompted the use of new therapeutic approaches. There are few data on systematic assessment of PAF control with stepwise dose escalation and the use of a drug combination. Low-dose quinidine may promote the efficacy of propafenone by inhibiting its degradation through the cytochrome P450 pathway (CYP2D6). We prescribed propafenone 300 to 450 mg/day to 60 patients with PAF for 8 weeks, and 62% were symptomatically controlled. The 19 refractory patients were randomized in a double-blinded fashion to receive either a higher dose of propafenone (450 to 675 mg/day) or the standard dose of propafenone with low-dose quinidine 150 mg/day, each for an 8-week study period, and subsequently crossed over to the alternative treatment. The resulting serum propafenone concentrations were 259 ± 208 and 336 ± 237 mg/day (p >0.5), respectively. Both treatment arms prolonged the time to the first symptomatic atrial fibrillation (AF) recurrence and the interval between attacks, and AF was controlled in 37% of patients. However, the higher dose of propafenone was associated with gastrointestinal side effects not present with the low-dose quinidine combination. Of the 10 refractory patients, 7 were further controlled with a standard dose of propafenone plus quinidine (600 mg/day). Overall, control of PAF was achieved in 85% of patients at the end of 8 months; adverse effects necessitating withdrawal were observed in 6%, and uncontrolled AF in 5% of patients. There was no difference in the mean AF rate during recurrences in all phases, and ventricular proarrhythmia was not seen. This study documents the role of stepwise antiarrhythmic treatment of PAF. The use of a standard dose of propafenone, followed by low-dose quinidine combination to reduce propafenone degradation, and the combined standard dose of propafenone and quinidine may be used to maximize efficacy and tolerability. (C) 2000 by Excerpta Medica, Inc.en_US
dc.languageengen_US
dc.publisherExcerpta Medica, Inc. The Journal's web site is located at http://www.ajconline.org/en_US
dc.relation.ispartofAmerican Journal of Cardiologyen_US
dc.subject.meshAdolescenten_US
dc.subject.meshAdulten_US
dc.subject.meshAgeden_US
dc.subject.meshAnalysis Of Varianceen_US
dc.subject.meshAnti-Arrhythmia Agents - Administration & Dosage - Adverse Effects - Blood - Therapeutic Useen_US
dc.subject.meshAtrial Fibrillation - Prevention & Controlen_US
dc.subject.meshCross-Over Studiesen_US
dc.subject.meshDose-Response Relationship, Drugen_US
dc.subject.meshDouble-Blind Methoden_US
dc.subject.meshDrug Combinationsen_US
dc.subject.meshFemaleen_US
dc.subject.meshHumansen_US
dc.subject.meshMaleen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshPropafenone - Administration & Dosage - Adverse Effects - Blood - Therapeutic Useen_US
dc.subject.meshProspective Studiesen_US
dc.subject.meshQuinidine - Administration & Dosage - Adverse Effects - Blood - Therapeutic Useen_US
dc.subject.meshRecurrenceen_US
dc.subject.meshSafetyen_US
dc.subject.meshTreatment Outcomeen_US
dc.titleControl of paroxysmal atrial fibrillation recurrence using combined administration of propafenone and quinidineen_US
dc.typeArticleen_US
dc.identifier.emailTse, HF:hftse@hkucc.hku.hken_US
dc.identifier.authorityTse, HF=rp00428en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1016/S0002-9149(00)01236-4en_US
dc.identifier.pmid11113407-
dc.identifier.scopuseid_2-s2.0-0034672492en_US
dc.identifier.hkuros62097-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0034672492&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume86en_US
dc.identifier.issue12en_US
dc.identifier.spage1327en_US
dc.identifier.epage1332en_US
dc.identifier.isiWOS:000165831200007-
dc.publisher.placeUnited Statesen_US
dc.identifier.scopusauthoridLau, CP=7401968501en_US
dc.identifier.scopusauthoridChow, MSS=16071149000en_US
dc.identifier.scopusauthoridTse, HF=7006070805en_US
dc.identifier.scopusauthoridTang, MO=7401973887en_US
dc.identifier.scopusauthoridFan, C=36339081800en_US

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