Pilsicainide for atrial fibrillation.
Pilsicainide is a class IC antiarrhythmic drug, which has a pure sodium channel blocking action with slow recovery pharmacokinetics. In experimental studies, pilsicainide has a depressant effect on intra-atrial conduction and a prolonging effect on the atrial effective refractory period (ERP). In patients with paroxysmal atrial fibrillation (AF), pilsicainide significantly prolonged the ERP of the distal pulmonary vein (PV), PV-left atrium (LA) junction and LA, and the conduction time from the distal PV to the PV-LA junction. In some patients, PV-LA conduction block has been observed just before pilsicainide-induced termination of AF; this isolation of the PV may provide a new insight into the mechanism of pharmacological conversion of AF. Hybrid therapy with pilsicainide and PV isolation (by radiofrequency catheter ablation) appears to be an effective therapeutic approach for AF. The pharmacological PV isolation by pilsicainide and its suppression of focal discharges from atrial tissue may prevent the development of AF after unsuccessful ablation.
Kumagai
Koichiro
K
Department of Cardiology, University Hospital of Fukuoka, 7-45-1 Nanajuma, Jonan-ku, Fukuoka 814-0180, Japan. kxk@fukuoka-u.ac.jp
Nakashima
Hideko
H
Tojo
Hideaki
H
Yasuda
Tomoo
T
Noguchi
Hiroo
H
Matsumoto
Naomichi
N
Ogawa
Masahiro
M
Saku
Keijiro
K
D000818:Animals; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000601:surgery; D017115:Catheter Ablation; D003131:Combined Modality Therapy; D022062:Electrophysiologic Techniques, Cardiac; D006801:Humans; D008012:Lidocaine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011667:Pulmonary Veins / Q000187:drug effects / Q000502:physiology; D026941:Sodium Channel Blockers / Q000627:therapeutic use*
D000889:Anti-Arrhythmia Agents; D026941:Sodium Channel Blockers; D008012:Lidocaine; C042288:pilsicainide