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Role of Transesophageal Pacing in Recurrent Atrial Fibrillation. Experience with Propafenone

Electrophysiology Laboratory, Ospedale Civile Ariano-AV, Ariano Irpino-AV, Italy

Pietro Guarino

Electrophysiology Laboratory, Ospedale Civile Ariano-AV, Ariano Irpino-AV, Italy

Antonella Parente

Electrophysiology Laboratory, Ospedale Civile Ariano-AV, Ariano Irpino-AV, Italy

Vincenzo Viola

Electrophysiology Laboratory, Ospedale Civile Ariano-AV, Ariano Irpino-AV, Italy

Fiore Candelmo

Electrophysiology Laboratory, Ospedale Civile Ariano-AV, Ariano Irpino-AV, Italy

Gennaro Bellizzi

Electrophysiology Laboratory, Ospedale Civile Ariano-AV, Ariano Irpino-AV, Italy

Antonio Foffa

Electrophysiology Laboratory, Ospedale Civile Ariano-AV, Ariano Irpino-AV, Italy

Alessandro Morella

Electrophysiology Laboratory, Ospedale Civile Ariano-AV, Ariano Irpino-AV, Italy

Domenico F. Martino

Electrophysiology Laboratory, Ospedale Civile Ariano-AV, Ariano Irpino-AV, Italy

To assess the role of transesophageal pacing (TP) at very high rates in the follow-up of patients with recurrent and sustained paroxysmal atrial fibrillation (AF) on therapy, the authors studied 15 patients (10 women, 5 men; aged forty- four to seventy-seven years old). Of them only 1 had a mild mitral regurgita tion; none had hyperthyroidism or acute ischemic heart disease. They tested propafenone (P) at a dose of 1.4-2 mg/kg over ten minutes as an intravenous bolus and 0.5 mg/minute as intravenous maintenance for two hours and then 300 mg twice daily orally and chronically. Serial TPs at very rapid rates (up to 600 bpm) were performed to test the long-term efficacy of P to prevent paroxys mal AF. The mean follow-up was fifteen months (nine to twenty-four months).

Results: Intravenous P converted AF in five to ninety minutes (mean twenty- one minutes) in 9/15 patients (conversion rate of 60%); in an additional 4 pa tients oral P converted AF in two to fifteen hours. In the other 2 patients P failed to convert AF. Three patients experienced recurrence of AF in the early follow- up. Of the 10 patients who completed the entire protocol, only 1, who had mild mitral prolapse regurgitation and AF induction by TP, experienced new epi sodes of AF during follow-up. No significant side effects were noted during P therapy.

Conclusions: Propafenone appears safe and effective for controlling and pre venting recurrent and sustained AF. Transesophageal pacing is a valid tool for predicting the efficacy of long-term therapy in the follow-up of patients with paroxysmal atrial fibrillation.

Angiology, Vol. 45, No. 2, 95-100 (1994)
DOI: 10.1177/000331979404500202


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