Oral loading of propafenone: restoring its role before restoring rhythm —authors’ reply

We wish to thank Martignaniet al.1 for their critical Letter to the Editor according to our article recently published inEuropace2 where they question our proposal that propafenone should not be generally excluded from cardioversion of paroxysmal atrial fibrillation in patients with structural heart disease. Recent2016European Society of CardiologyGuidelines for the Management of Atrial Fibrillation3 support the use of propafenone for acute pharmacological cardioversion in patients with new onset of atrial fibrillation. However, their restriction that propafenone should only be given to patients without structural heart disease3 particularly bases on CAST (theCardiac Arrhythmias Suppression Trial),4 where long-term administration of flecainide and encainide, two other Class Ic antiarrhythmic agents without β-blocking effects, increased mortality when given to patients with ventricular arrhythmias and coronary artery disease.
Source: Europace - Category: Cardiology Source Type: research