Brugada type electrocardiographic changes induced by concomitant use of lithium and propafenone in patient with Wolff-Parkinson-White syndrome.

We report a case of ST elevation in right precordial leads compatible with type 1 Brugada syndrome following administration of propafenone in a patient with Wolff-Parkinson-White syndrome who was receiving lithium at concentrations within therapeutic levels. The mechanism of the electrocardiogram changes was considered to be caused by the two drugs synergistic sodium channel blocking effects.

Uncommon cause of syncope in patient with bundle branch block and negative electrophysiological study.

We report a case study of a patient with bifascicular block, episodes of syncope, and negative electrophysiological study (EPS) who diagnosed to have sinus arrest with the help of an implantable loop recorder. This case emphasizes that atrioventricular (AV) block is not the only mechanism of syncope in patients with bundle branch block (BBB) and negative EPS.

Efficacy and safety of ibutilide for cardioversion of atrial flutter and fibrillation in patients receiving amiodarone or propafenone.

AIM: The effectiveness and safety of ibutilide (IB) use in patients receiving amiodarone or propafenone for atrial flutter (AFL) and atrial fibrillation (AF) were compared to IB alone. METHODS AND RESULTS: In 104 consecutive patients with AF (65%) or AFL (35%), receiving amiodarone (n = 46), propafenone (n = 30), or no specific antiarrhythmic drug (n = 28), IB was given for cardioversion. Fifteen patients in amiodarone group were loaded with 1.2 g intravenously before IB administration. The mean duration of arrhythmia episode was 23 +/- 65 days, while 85% of patients had structural heart disease. The left ventricle ejection fraction was 57 +/- 10% and the left atrium size was 4.2 +/- 0.6 cm. The conversion efficacy did not differ among groups (62% for amiodarone vs 55% for propafenone vs 64% for IB alone). The QTc intervals were significantly prolonged, at 10 minutes and 30 minutes after IB administration, in amiodarone group (from 449 +/- 88 to 496 +/- 92 ms, 508 +/- 52 ms; P = 0.001) and in the group where IB was used alone (from 434 +/- 45 to 517 +/- 74 ms, 492 +/- 65 ms; P < 0.001), while it remained unchanged in propafenone group (from 464 +/- 52 to 471 +/- 80 ms, 489 +/- 93 ms; P = 0.536). The only predictor of conversion was the presence of AFL (P = 0.009). Five patients developed ventricular tachycardias after IB administration (two in propafenone, one in amiodarone, and two in IB group). CONCLUSIONS: The use of IB in patients receiving amiodarone or propafenone for AFL or AF is equally effective and safe as the use of IB alone. The presence of AFL is the stronger predictor factor for cardioversion.