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A Case of Sudden Cardiac Death due to Pilsicainide-Induced Torsades de Pointes
Shimpei Nakatani,Masayuki Taniike,Nobuhiko Makino, MD,Yasuyuki Egami,Ryu Shutta,Jun Tanouchi,Masami Nishino 대한심장학회 2014 Korean Circulation Journal Vol.44 No.2
An 84-year-old male received oral pilsicainide, a pure sodium channel blocker with slow recovery kinetics, to convert his paroxysmal atrialfibrillation to a sinus rhythm; the patient developed sudden cardiac death two days later. The Holter electrocardiogram, which was wornby chance, revealed torsade de pointes with gradually prolonged QT intervals. This drug is rapidly absorbed from the gastrointestinal tract,and most of it is excreted from the kidney. Although the patient’s renal function was not highly impaired and the dose of pilsicainide waslow, the plasma concentration of pilsicainide may have been high, which can produce torsades de pointes in the octogenarian. Althoughthe oral administration of class IC drugs, including pilsicainide, is effective to terminate atrial fibrillation, careful consideration must betaken before giving these drugs to octogenarians.