Keywords
Monomorphic Ventricular Tachycardia
Propafenone
Sodium bicarbonate
Case Report
Categories
How to Cite
Abstract
We present the case of a 74-year-old male with a history of paroxysmal atrial fibrillation (PAF) and chronic kidney disease (CKD) who presented with fatigue. During hospitalization, telemetry captured an episode of hemodynamically stable wide-complex tachycardia consistent with monomorphic ventricular tachycardia. A 12-lead ECG revealed atrioventricular dissociation and a widened QRS complex. After discontinuing propafenone and initiating oral sodium bicarbonate due to limited intravenous availability, ECG abnormalities gradually improved over several hours, and the rhythm reverted to baseline PAF. A subsequent laboratory test confirmed supratherapeutic propafenone levels. This case highlights a temporally associated improvement in suspected propafenone cardiotoxicity with oral sodium bicarbonate in a hemodynamically stable patient. Written informed consent for publication was obtained.
References
1. Paolini E, Stronati G, Guerra F, Capucci A. Flecainide: Electrophysiological properties, clinical indications, and practical aspects. Pharmacol Res. 2019: 104443 [PMID: 31493514, https://doi.org/10.1016/j.phrs.2019.104443]
2. Mahendru D, Joshi HD, Kowey P. Dofetilide in atrial fibrillation: A comprehensive review. Indian Pacing Electrophysiol J. 2025: 451 [PMID: 41319865, https://doi.org/10.1016/j.ipej.2025.11.013]
3. Colangelo T, Johnson D, Ho R. Flecainide-Induced Atrial Flutter With 1:1 Conduction Complicated by Ventricular Fibrillation After Electrical Cardioversion. Tex Heart Inst J. 2021: [PMID: 34086956, https://doi.org/10.14503/THIJ-19-7099]
4. Di Grande A, Giuffrida C, Narbone G, Le Moli C, Nigro F, Di Mauro A, Pirrone G, Tabita V, Alongi B. Management of sodium-channel blocker poisoning: the role of hypertonic sodium salts. Eur Rev Med Pharmacol Sci. 2010: 25 [PMID: 20184086,
5. Vu NM, Hill TE, Summers MR, Vranian MN, Faulx MD. Management of life-threatening flecainide overdose: A case report and review of the literature. HeartRhythm Case Rep. 2016: 228 [PMID: 28491675, https://doi.org/10.1016/j.hrcr.2015.12.013]
6. Denaro CP, Benowitz NL. Poisoning due to class 1B antiarrhythmic drugs. Lignocaine, mexiletine and tocainide. Med Toxicol Adverse Drug Exp. 1989: 412 [PMID: 2513464, https://doi.org/10.1007/BF03259923]
7. Enginyurt Ö, Karabulut Özer M, Çoruh Akyol B, Süleyman H. Detection of Mushroom Extract Use in Patients Coming to the Family Medicine Outpatient Clinic for Routine Check-up and the Relationship Between Changes in Their Clinics. Middle Black Sea Journal of Health Science. 2025: 136 https://doi.org/10.19127/mbsjohs.1665455]
8. Haddad E, Collins M. A case of propafenone toxicity in the setting of dehydration and acute kidney injury. Glob Cardiol Sci Pract. 2024: e202438 [PMID: 39351481, https://doi.org/10.21542/gcsp.2024.38]
9. Kim HK, Kim SS, Ki YJ, Park KH, Choi DH. Ventricular Tachycardia in Association with Propafenone Overdose. Acta Cardiol Sin. 2021: 100 [PMID: 33488033, https://doi.org/10.6515/ACS.202101_37(1).20200914A]
10. Bogossian H, Linz D, Heijman J, Bimpong-Buta NY, Bandorski D, Frommeyer G, Erkapic D, Seyfarth M, Zarse M, Crijns HJ. QTc evaluation in patients with bundle branch block. Int J Cardiol Heart Vasc. 2020: 100636 [PMID: 32995475, https://doi.org/10.1016/j.ijcha.2020.100636]
11. Merino JL, Tamargo J, Blomstrom-Lundqvist C, Boriani G, Crijns H, Dobrev D, Goette A, Hohnloser SH, Naccarelli GV, Reiffel JA, Tfelt-Hansen J, Martinez-Cossiani M, Camm AJ, Almendral Garrote JM, Sredniawa B, Kulakowski P, Savelieva I, Potpara T, Gorenek B, Zamorano JL. Practical compendium of antiarrhythmic drugs: a clinical consensus statement of the European Heart Rhythm Association of the European Society of Cardiology. Europace. 2025: [PMID: 40159403, https://doi.org/10.1093/europace/euaf076]
12. Darbar D. Standard antiarrhythmic drugs. Cardiac electrophysiology: from cell to bedside: Elsevier; 2014. p. 1095-1110.
13. Podrid PJ, Anderson JL. Safety and tolerability of long-term propafenone therapy for supraventricular tachyarrhythmias. The Propafenone Multicenter Study Group. Am J Cardiol. 1996: 430 [PMID: 8752188, https://doi.org/10.1016/s0002-9149(96)00332-3]
14. Lei M, Wu L, Terrar DA, Huang CL. Modernized Classification of Cardiac Antiarrhythmic Drugs. Circulation. 2018: 1879 [PMID: 30354657, https://doi.org/10.1161/CIRCULATIONAHA.118.035455]
15. Lavonas EJ, Akpunonu PD, Arens AM, Babu KM, Cao D, Hoffman RS, Hoyte CO, Mazer-Amirshahi ME, Stolbach A, St-Onge M, Thompson TM, Wang GS, Hoover AV, Drennan IR, American Heart A. 2023 American Heart Association Focused Update on the Management of Patients With Cardiac Arrest or Life-Threatening Toxicity Due to Poisoning: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2023: e149 [PMID: 37721023, https://doi.org/10.1161/CIR.0000000000001161]
16. Ferreira AI, Macedo Silva V, Arieira C, Xavier S, Magalhaes J, Cotter J. Propafenone-Induced Cholestatic Liver Injury: When Diagnosis Does Not Skip a Beat. GE Port J Gastroenterol. 2025: 212 [PMID: 40469208, https://doi.org/10.1159/000541557]
17. Han YY, George C, Garg U, Oroszi G. Use of therapeutic plasma exchange to enhance propafenone elimination following intentional drug overdose. Toxicology Cases for the Clinical and Forensic Laboratory: Elsevier; 2020. p. 203-207.
18. Yilmaz T, Osoydan Satici M, İSlam MM, ÖZdemİR S, EroĞLu SE, Aksel G. Spontaneous Resolution Of Arrhythmia in Propafenone Intoxication: A Rare Case Report. Eurasian Journal of Toxicology. 2022: 29 https://doi.org/10.51262/ejtox.1080167]
19. Sinha F, Schweda F, Maier LS, Wagner S. Impact of Impaired Kidney Function on Arrhythmia-Promoting Cardiac Ion Channel Regulation. Int J Mol Sci. 2023: [PMID: 37762501, https://doi.org/10.3390/ijms241814198]
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