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

Abstract

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.

Keywords

• Propafenone
• Takotsubo
• Cardiomyopathy

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

Abstract

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.

Keywords

• Takotsubo
• Propafenon
• Kardiyomiyopati

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