Propafenone triggering Atrial flutter and SVT

[nano-science]

Hi All,

I had a second ablation for persistent high load (18,000/ day) PVC's and non-sustained ventricular tachycardia, unfortunately after 3 months they reappeared in similar numbers. I was put on Propafenone (150x3 mg times a day) and then increased morning and evening doses to 225 mg.

Propafenone reduced the PVC load significantly, but unfortunately last night I had three episodes spaced by 2 hours, what seemed to be atrial flutter or other SVT (with PVC's too). First two were exactly 100 beats per minute I was shivering and shaking, and then 140 beats per minute landing me in A&E.

So far I had stopped the Propafenone and the ectopics pretty low, but appear more when I just have a light walk.

Could anyone who has the experience with Propafenone (Rhytmol, Arrhytmol) let me know whether popafenone can trigger the atrial flutter, or supraventricular arrhythmias the very things it meant to suppress?

Thanks to all on this very helpful forum!

[BobD Volunteer]

Never did for me on even higher dose over many years. Not saying it can't as we are all different but I have never been aware of this as a risk.

[nano-science in reply to BobD]

Thanks - great that it worked fo you! Take care.

[Hidden]

I had no problems with Propafenone.

However it is known, like Flecainide, to be proarrythmic, and can very occasionally cause atrial flutter.

[nano-science in reply to Hidden]

Hi, just seen the cardiologist today - it looks that it can do both depending on the body. Great that some drugs work for some.

[Finvola]

I’ve had runs of AFlutter induced by Flecainide but I read that Class IC anti-arrhythmic drugs such as Flecainide and Propafanone can be pro-arrhythmic, especially causing 1:1 Atrial Flutter.

Many EP’s recommend a beta blocker with Flecainide for this reason and I understand that Propafanone already has beta blocking properties. This reduces the chance of 1:1 conduction of AFlutter signals.

It’s sort of a catch-22 isn’t it? Take the drugs and you may get flutter, don’t, and you get something worse! It really is a personal decision of which is the least bad choice. I talked it over with my EP and decided to stick with Flecainide as the rate isn’t too bad at about 110bpm and the runs are short and infrequent.

Have a talk with your physician regarding the best option for you - hopefully, you’ll get a good outcome.

[nano-science in reply to Finvola]

Hi Finvola! The propafenone for me had very little beta-blocking as my heart rate went into 80-90, whereas on bisoprolol it was 60-70. Some cardiologists advice to have both just controlling the rate and ECG for the deviations. Most of physicians have little idea of the medication except of electrphysicologists who I consult.

[Buffafly]

I took Propafenone for many years but eventually developed flutter as well as AF and it was stopped after ablation. I also used to have bad ectopics which I think is why it was prescribed for me. I wouldn't want to take it again!

[nano-science in reply to Buffafly]

Dear Buffaly, many thanks! It looks that I had very sparse episodes of Aflutter (once every few months before) but with increased propafenone that came every night - sometimes several times. The bodies are responding in a different way.

[nano-science]

Thank you! I had flutter with both, and you are right these drugs are VERY individual so the EP are aware of it.

[rebecca_dewinter]

Dear Nano-science, I hope you are doing well these days. I happened upon your posts shortly after a disastrous ablation for PVCs and NSVT. Like you, I am (was?) an active, fit 57 year-old who didn't want to take medication daily and was bothered by periods of dizziness during activity. I opted for the ablation even though my total PVC load was considered relatively low and unlikely to induce cardiomyopathy. During the procedure I developed a pericardial bleed leading to a PEA (pulseless electrical activity) cardiac arrest and respiratory failure requiring CPR and intubation. I woke up on a ventilator in the ICU. That was 2.5 weeks ago and now that I am getting back to a semi-normal routine I am noticing the PVCs and (probably) runs of NSVT---while walking the dog, for example. So now I am wondering whether the ablation was effective at all and whether there was permanent damage done to my heart. Are you still having ventricular ectopy? Did anyone ever say how long the healing phase can last and whether one can expect improvement as time goes by?

I wish I had seen you warning to those of us with "benign" arrhythmias! The procedure is not without risks and sometimes it simply doesn't work or may make things worse! I am lucky to be alive.