Propafenone Induced Takotsubo Cardiomyopathy: A Mere Coincidence or A New Causal Relationship?

Yıl 2023, Cilt: 25 Sayı: 3, 297 - 301, 30.12.2023

Fahri Çakan Adem Adar

https://doi.org/10.18678/dtfd.1307722

Cited By: 1

Öz

Propafenone is a class 1C antiarrhythmic drug that blocks sodium channels and is used in the treatment of arrhythmia. Because of its rapid effect on terminating paroxysmal episodes of atrial fibrillation, it can be used as a pill-in-the-pocket. In patients with structural heart disease, it is less preferred due to cardiotoxic effects in long-term use. Although propafenone use is known to cause several cardiovascular side effects, the development of Takotsubo cardiomyopathy is unknown. Propafenone toxicity at standard doses is a rare condition. Propafenone plasma concentrations may increase through inhibition of cytochrome P450 2D6 and complete inhibition of 2D6 metabolism can increase propafenone levels by up to 3 to 10 times. In this case report, we aimed to present a 37-year-old female patient who developed Takotsubo cardiomyopathy and cardiogenic shock after the first dose of propafenone use and recovered with medical treatment.

Anahtar Kelimeler

Propafenone, Takotsubo, Cardiomyopathy

Propafenona Bağlı Gelişen Takotsubo Kardiyomiyopatisi: Sadece Bir Tesadüf mü, Yeni Bir Nedensel İlişki mi?

Öz

Propafenon, sodyum kanallarını bloke eden ve aritmi tedavisinde kullanılan, sınıf 1C antiaritmik bir ilaçtır. Atriyal fibrilasyonun paroksismal ataklarını sonlandırmadaki hızlı etkisi nedeniyle “cep hapı” olarak kullanılmaktadır. Uzun süreli kullanımlarda meydana getirdiği kardiyotoksik etkilerinden dolayı yapısal kalp hastalığı olan bireylerde daha az tercih edilmektedir. Propafenon kullanımının çeşitli kardiyovasküler yan etkilere neden olduğu bilinmesine rağmen, Takotsubo kardiyomiyopatisi gelişimi bilinmemektedir. Standart dozlarda propafenon toksisitesi nadir olarak gözlenen bir durumdur. Propafenon plazma konsantrasyonları, sitokrom P450 2D6'nın inhibisyonu yoluyla artabilir ve 2D6 metabolizmasının tamamen inhibisyonu, propafenon düzeylerini 3 ila 10 kata kadar arttırabilir. Bu vaka sunumunda ilk doz propafenon kullanımı sonrasında Takotsubo kardiyomiyopatisi ve kardiyojenik şok gelişen ve medikal tedavi ile düzelen 37 yaşında kadın hastanın sunulması amaçlanmıştır.

Anahtar Kelimeler

Takotsubo, Propafenon, Kardiyomiyopati

Kaynakça

• Pal S, Broker M, Wagner H, Aronow WS, Frishman WH. Stress (takotsubo) cardiomyopathy: a review of its pathophysiology, manifestations, and factors that affect prognosis. Cardiol Rev. 2021;29(4):205-9.
• Shim IK, Kim BJ, Kim H, Lee JW, Cha TJ, Heo JH. A case of persistent apical ballooning complicated by apical thrombus in takotsubo cardiomyopathy of systemic lupus erythematosus patient. J Cardiovasc Ultrasound. 2013;21(3):137-9.
• Viland J, Langorgen J, Wendelbo O. Correction: A somnolent woman in her fifties with acute circulatory failure. Tidsskr Nor Laegeforen. 2019;139(10). Norwegian.
• Scantlebury DC, Prasad A. Diagnosis of takotsubo cardiomyopathy. Circ J. 2014;78(9):2129-39.
• Podrid PJ, Anderson JL. Safety and tolerability of long-term propafenone therapy for supraventricular tachyarrhythmias. The Propafenone Multicenter Study Group. Am J Cardiol. 1996;78(4):430-4.
• Koppel C, Oberdisse U, Heinemeyer G. Clinical course and outcome in class IC antiarrhythmic overdose. J Toxicol Clin Toxicol. 1990;28(4):433-44.
• Yeung A, Shanks D, Parwana H, Gin K. Acute propafenone toxicity after two exposures at standard dosing. Can J Cardiol. 2010;26(6):209-10.
• Kerns W 2nd, English B, Ford M. Propafenone overdose. Ann Emerg Med. 1994;24(1):98-103.
• Alboni P, Botto GL, Baldi N, Luzi M, Russo V, Gianfranchi L, et al. Outpatient treatment of recent-onset atrial fibrillation with the "pill-in-the-pocket" approach. N Engl J Med. 2004;351(23):2384-91.
• Viland J, Langorgen J, Wendelbo O. A somnolent woman in her fifties with acute circulatory failure. Tidsskr Nor Laegeforen. 2019;139(9). Norwegian.
• Brubacher J. Bicarbonate therapy for unstable propafenone-induced wide complex tachycardia. CJEM. 2004;6(5):349-56.
• Ari ME, Ekici F. Brugada-phenocopy induced by propafenone overdose and successful treatment: a case report. Balkan Med J. 2017;34(5):473-5.
• Chutani S, Imran N, Grubb B, Kanjwal Y. Propafenone induced Brugada-like ECG changes mistaken as acute myocardial infarction. BMJ Case Rep. 2009;2009:bcr12.2008.1389.
• Antzelevitch C, Brugada P, Borggrefe M, Brugada J, Brugada R, Corrado D, et al. Brugada syndrome: report of the second consensus conference: endorsed by the Heart Rhythm Society and the European Heart Rhythm Association. Circulation. 2005;111(5):659-70.
• Yiginer O, Kilicaslan F, Tokatli A, Isilak Z. Concealed Brugada syndrome that became apparent incidentally during atrial fibrillation therapy. Turk Kardiyol Dern Ars. 2011;39(2):159-62. Turkish.
• Matana A, Goldner V, Stanić K, Mavrić Z, Zaputović L, Matana Z. Unmasking effect of propafenone on the concealed form of the Brugada phenomenon. Pacing Clin Electrophysiol. 2000;23(3):416-8.
• Beldner S, Lin D, Marchlinski FE. Flecainide and propafenone induced ST-segment elevation in patients with atrial fibrillation: clue to specificity of Brugada-type electrocardiographic changes. Am J Cardiol. 2004;94(9):1184-5.
• Gil J, Marmelo B, Abreu L, Antunes H, Santos LFD, Cabral JC. Propafenone overdose: from cardiogenic shock to Brugada pattern. Arq Bras Cardiol. 2018;110(3):292-4.
• Wożakowska-Kapłon B, Stępień-Walek A. Propafenone overdose: cardiac arrest and full recovery. Cardiol J. 2010;17(6):619-22.
• Clarot F, Goullé JP, Horst M, Vaz E, Lacroix C, Proust B. Fatal propafenone overdoses: case reports and a review of the literature. J Anal Toxicol. 2003;27(8):595-9.