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Anti-arrhythmics with propensity for pro-arrhythmic effects (i) " One should never give a drug such as propafenone or flecainide in the absence of a potent AV nodal blocker. Digitalis, in my opinion, is not a potent AV nodal blocker for most patients. Otherwise, the atrial rate can slow to a flutter-like rhythm, often relatively slow flutter with rates in the atrium of 200 to 240 bpm. In some patients this can result in a 1:1 AV conduction, and this can lead to a bizarre wide QRS complex that would mimic ventricular tachycardia." Eric N Prystowsky MD Case studies / Therapy for irregular atrial rhythm (August 8, 2000) Anti-arrhythmics with propensity for pro-arrhythmic effects (ii) "It is important to be sure there is no coronary artery disease before using drugs such as propafenone and flecainide in a population of patients where coronary artery disease can be expected to occur. " Eric N Prystowsky MD Case studies / Therapy for irregular atrial rhythm (August 8, 2000)