Korean Circ J.  2014 Mar;44(2):122-124. 10.4070/kcj.2014.44.2.122.

A Case of Sudden Cardiac Death due to Pilsicainide-Induced Torsades de Pointes

• Nakatani S
• Taniike M
• Makino N
• Egami Y
• Shutta R
• Tanouchi J
• Nishino M

• KMID: 2223902
• DOI: http://doi.org/10.4070/kcj.2014.44.2.122

Abstract

An 84-year-old male received oral pilsicainide, a pure sodium channel blocker with slow recovery kinetics, to convert his paroxysmal atrial fibrillation to a sinus rhythm; the patient developed sudden cardiac death two days later. The Holter electrocardiogram, which was worn by 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 was low, the plasma concentration of pilsicainide may have been high, which can produce torsades de pointes in the octogenarian. Although the oral administration of class IC drugs, including pilsicainide, is effective to terminate atrial fibrillation, careful consideration must be taken before giving these drugs to octogenarians.

Keyword

Pilsicainide; Torsades de pointes; Sudden cardiac death

MeSH Terms

Administration, Oral
Aged, 80 and over
Atrial Fibrillation
Death, Sudden, Cardiac*
Electrocardiography
Gastrointestinal Tract
Humans
Kidney
Kinetics
Male
Sodium Channel Blockers
Torsades de Pointes*
Sodium Channel Blockers

Figure

• 

  Fig. 1 CM5 lead of Holter electrocardiogram showed sinus rhythm with normal QT and QTc interval (320 msec and 400 msec, respectively) at the start of the recording.

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  Fig. 2 The Holter electrocardiogram showed mutual findings of atrial fibrillation and torsades de pointes.

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  Fig. 3 Magnified Holter electrocardiogram recordings showed torsades de pointes, which was initiated by the R-on-T ectopic beat (CM5 lead).

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  Fig. 4 The changes of QTc intervals in the Holter ECG. The QTc interval was gradually prolonged during the Holter ECG monitoring. ECG: electrocardiogram.

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  Fig. 5 The QTc interval was clearly prolonged compared with that of the initial Holter ECG, and the width of the QRS complexes was slightly prolonged compared with that of the initial Holter ECG. The RR interval was similar during the Holter ECG monitoring. ECG: electrocardiogram.

Reference

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