单次口服常量普罗帕酮致老年心房颤动患者严重窦性停搏

Severe Sinus Arrest Caused by Propafenone of a Single Conventional Dosage by Oral Administration on an Elderly Patient with Atrial Fibrillation

目的探讨普罗帕酮抗心律失常治疗中的误用及原因。方法回顾性分析1例老年心房颤动(房颤)患者口服普罗帕酮致严重窦性停搏的临床资料并复习相关文献。结果本例为86岁冠心病患者,房颤,表现为右束支、左前分支传导阻滞,心室率107/min时心电图表现为明显的ST段缺血性压低。予口服150 mg普罗帕酮57 min后出现长达近11 s的窦性停搏,其后缓慢性窦性心律与交界性逸搏心律交替出现持续1d。患者最终置入永久性心脏起搏器。结论对老年房颤患者要警惕心脏起搏传导系统退行性改变。缺血性心脏病为普罗帕酮禁忌证,常量口服即可引起严重不良反应。

Objective To discuss the misuse and causes of propafenone in treatment of arrhythmia.Methods The clinical data of one elderly patient with atrial fibrillation treated with oral administration of propafenone were respectively analyzed,and the pertinent literatures was reviewed.Results The 86-year-old patient with coronary heart disease in both of right bundle branch block and left anterior fascicle block suffered atrial fibrillation.There was significant ischemic depression of ST segment on electrocardiogram while the ventricular rate was only 107 beats per minute.He was given 150 mg of propafenone for oral administration,and severe sinus arrest lasted for nearly 11 seconds and 57 min after administration.Subsequently brady sinus rhythm and junctional escape rhythrn lasted alternately for one day.The patient was finally planted with a permanence cardiac pacemaker.Conclusion Elderly patients with atrial fibrillation are often accompanied with degeneration of cardiac pacing conduction system.Propafenone is contraindicated in patients with ischemic heart disease,because oral administration of a conventional oral dosage even may lead to serious adverse reaction.