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European Heart Journal 1992 13(2):269-274;
Copyright © 1992 by the European Society of Cardiology.
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© 1992 The European Society of Cardiology

Rate-dependent failure of ventricular capture in patients treated with oral propafenone

J. SORIANO*, J. ALMENDRAL*,, A. ARENAL*, D. SAN ROMÁN*, J. L. DELCAN* and M. E. JOSEPHSON{dagger}

*Servicio de Cardiologia, Hospital General Gregorio Marañón Madrid, Spain
{dagger}Clinical Electrophysiology Laboratory, Hospital of the University of Pennsylvania, Cardiovascular Section, Department of Medicine, University of Pennsylvania School of Medicine Philadelphia, Pennsylvania, U.S.A.

Received 29 March 1990; revised 25 January 1991; .

Correspondence. Jesús Almendral, Cardiologia (planta 5). HOspital General Gregorio Marañón, Doctor Esquerdo, 46,28007-Madrid, Spain

Abstract

The effects of propafenone on ventricular excitability were studied in 18 patients after 9 ± 6 days on oral propafenone (900 mg/day). Late diastolic double threshold right ventricular stimulation was performed at variable rates. In five patients (28%, groupI) an intermittent, rate-dependent failure of ventricular capture was reproducibly observed during stimulation at rates above the sinus rhythm but not exceeding 150 beats min–1. In four patients loss of capture was preceded by gradual prolongation of the interval between the stimulus art fact and the local right ventricular bipolar electrogram. Such findings were not observed in the remaining 13 patients (group II) on propafenone nor in 28 studies in the same patients on different antiarrhythmic agents. Group I vs group II patients were older (72±4 vs 53±18 years, P=0.002), had longer right ventricular effective refractory periods on the baseline (P = 0.004) and on propafenone (P = 0.0003), and had longer QRS duration on propafenone. The increase produced by propafenone in sinus rhythm QRS duration, paced QRS duration and ventricular effective refractory period was greater in group I than in group II: 42 ± 36 vs 14 ± 12 ms, P = 0.01, 94 ± 43 vs 34 ± 26 ms, P = 0.0002, 88 ± 64 vs 22 ± 37 ms, P = 0.025, respectively. Thus propafenone can produce rate-dependent failure of ventricular capture which is associated with marked prolongation of refractoriness and QRS duration suggesting a marked use-dependent drug effect in selected patients.

Key Words: Propafenone • excitability • wenckebach phenomenon • refractoriness • QRS duration


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