Effects of acute and prolonged administration of propafenone on internal defibrillation in the pig

Some antiarrhythmic sodium channel blocking drugs have been found to increase the energy necessary for internal defibrillation. Propafenone is a new drug that has been shown to be efficacious in the therapy of supraventricular and ventricular arrhythmias, and is of potential use in patients with defibrillators. The effects of short-term and prolonged propafenone administration on the internal defibrillation threshold (DFT) were determined in 43 pigs randomized to one of four groups: saline infusion (n = 10); propafenone infusion (n = 10); placebo administration for 8 days (n = 10); or propafenone administration for 8 days (n = 13). Two mesh electrodes were sutured on the right lateral and left lateral epicardial surface and current was delivered from the right electrode to the left electrode. Triplicate DFTs were obtained before and at 40 and 80 minutes after infusion of drug or placebo. In pigs receiving long-term administration, after baseline DFTs were obtained the electrodes were removed and the chest was closed. Following 8 days of drug or placebo administration, DFTs were redetermined. No changes were observed in the short- or long-term control groups. DFTs were lower after propafenone administration; either short-term infusion (20 ± 6.2 joules at baseline; 15.6 ± 5 joules at 40 minutes, p <0.05; 10.2 ± 6 joules at 80 minutes, p <0.001) or long-term administration (17.8 ± 2.6 joules at baseline versus 12 ± 3.2 joules on drug, p <0.002). Decreased ventricular cycle lengths were found with acute administration of propafenone. Three pigs died during long-term administration of propafenone. In this model, with propafenone administration a significant improvement in defibrillation efficacy was observed that could be of clinical importance if verified in patients.