title: A case of the toxicity of pilsicainide hydrochloride with comparison of the serial serum pilsicainide levels and electrocardiographic findings.
abstract: We treated an 88-year-old man with aortic valvular stenosis/insufficiency and paroxysmal atrial fibrillation, who developed ventricular tachycardia due to pilsicainide toxicity. He was treated at the outpatient clinic of his local hospital, and was administered pilsicainide (100 mg/day) for atrial fibrillation. The electrocardiographic findings on admission to our hospital indicated wide QRS with frequent episodes of ventricular tachycardia. We diagnosed him as having pilsicainide toxicity because of a low cardiac output and renal dysfunction. His creatinine level was 2.4 mg/dL and the serum pilsicainide level was 2.42 microg/mL on admission. Fluid infusion and continuous hemodiafiltration were performed to achieve an early reduction in the serum pilsicainide level. His serum pilsicainide concentration was significantly decreased by these treatments, and the prolongation of the QTc and ventricular tachycardia improved in parallel to the decrease in the serum pilsicainide level. The changes in the serum pilsicainide level showed a significant positive correlation with the changes in the electrocardiographic findings (PQ, QRS, ST intervals, and QTc). Pilsicainide should be administered with great care to elderly patients, especially patients with cardiac dysfunction and renal dysfunction. Estimation of the serum level may be possible from the electrocardiographic findings if the pilsicainide toxicity occurs.
authors.affiliation: Department of Cardiology, Ishikawa Prefectural Central Hospital, Ishikawa 920-8530, Japan.
authors.forename: Yuhki
authors.initials: Y
authors.lastname: Horita
authors.forename: Honin
authors.initials: H
authors.lastname: Kanaya
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Uno
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Yamazaki
authors.forename: Bunji
authors.initials: B
authors.lastname: Kaku
authors.forename: Akira
authors.initials: A
authors.lastname: Funada
authors.forename: Susumu
authors.initials: S
authors.lastname: Kitajima
authors.forename: Masami
authors.initials: M
authors.lastname: Matsumura
authors.forename: Takashi
authors.initials: T
authors.lastname: Satoh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000188:drug therapy; D003404:Creatinine / Q000097:blood; D062787:Drug Overdose; D004562:Electrocardiography; D006801:Humans; D008012:Lidocaine / Q000009:adverse effects* / Q000031:analogs & derivatives* / Q000097:blood*; D008297:Male; D017180:Tachycardia, Ventricular / Q000139:chemically induced* / Q000503:physiopathology
chemical_list: D000889:Anti-Arrhythmia Agents; D008012:Lidocaine; C042288:pilsicainide; D003404:Creatinine