Department of Cardiology, Bristol Heart Institute, Bristol Royal Infirmary, Bristol, UK.
Emerg Med J. 2009 Dec;26(12):904-5. doi: 10.1136/emj.2008.066688.
A 58-year-old man presented to the emergency department with sudden onset rapid palpitations and significant presyncope while walking on the flat. The previous day he had undergone DC cardioversion for atrial fibrillation (AF) which had been initially successful. However, 6 h after cardioversion he was aware of intermittently raised but regular heart rates. On arrival at the emergency department (ED) he was well with no haemodynamic compromise. The ECG showed an atrial tachycardia instead of AF. Medications consisted of propafenone 300 mg twice daily, bisoprolol 5 mg at night and warfarin. Bisoprolol was increased to 5 mg twice daily and he was discharged with a plan for outpatient ablation. He collapsed in the hospital car park with rapid palpitations, chest tightness and vagal symptoms. On return to the ED he was hypotensive with a heart rate of 200 bpm. The ECG showed 1:1 atrioventricular conduction (AV) of the atrial tachycardia which promptly improved after administering intravenous atenolol. Class 1c antiarrhythmic agents such as propafenone can precipitate 1:1 AV conduction of atrial tachycardias resulting in dangerous exacerbations of ventricular rate or even malignant tachyarrhythmias. It is therefore essential that concomitant AV blocking agents are used both prophylactically or acutely in suspected cases.
一位 58 岁男性在平地行走时突发快速心悸和明显晕厥，到急诊科就诊。前一天他因心房颤动（AF）行直流电复律，起初效果良好。然而，复律后 6 小时，他自觉心率间歇性升高但规则。到达急诊科时，他生命体征平稳，无血流动力学障碍。心电图显示房性心动过速而非 AF。目前的用药包括普罗帕酮 300mg，每日两次；比索洛尔 5mg，每晚一次；华法林。比索洛尔增加至每日两次，并计划门诊消融。他在医院停车场突然出现快速心悸、胸闷和迷走神经症状后晕倒。返回急诊科时，他血压低，心率 200 次/分。心电图显示房性心动过速 1:1 房室传导，静脉注射阿替洛尔后迅速改善。普罗帕酮等 1C 类抗心律失常药物可诱发房性心动过速 1:1 房室传导，导致心室率危险恶化，甚至出现恶性心动过速。因此，在疑似病例中，预防性或急性使用同时具有房室阻滞作用的药物非常重要。
