In all cases, electrocardiographic abnormalities such as VT and wide QRS
were reported. Except for that in an autopsy report4), the serum concentration of pilsicainide on
admission was highest in our case. There is a report of a patient who
suffered severe shock after taking 2000 mg of pilsicainide and whose
maximum serum concentration rose to 4.81 μg/ml and was saved by PCPS and
IABP, as in our case. Temporary pacing and HD have also been reported as
other treatments.
Pilsicainide is excreted renally
at a high urinary excretion rate of unchanged drug of 80%5) and has a blood half-life of 3.4 ± 0.2 hours. The
blood half-life is markedly prolonged to 23.7 ± 0.2 hours when
creatinine clearance is less than 20 ml/min. There are no antidotes or
antagonists for pilsicainide, and its removal rate is reported to be as
low as 37% on HD, 25% on hemofiltration dialysis, and 45% on plasma
exchange. Because a slight decrease in the serum concentration of
pilsicainide has been reported to improve symptoms 6)and repeated polymorphic VT occurred in our case, we intervened with HD
to try to immediately decrease the serum concentration. Magnesium
sulfate was reported 7) as another treatment option.
We consider it to be effective and thus administered it for arrhythmia
prophylaxis in our case.