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.