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.