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  • It is recommended that pilsicainide be administered over min

    2019-06-25

    It is recommended that pilsicainide be administered over 10min, with 1.0mg/kg being the maximum daily dosage allowed. However, a single oral dose of pilsicainide has been shown to be effective, feasible and safe, and the single dose is always from 100 to 150mg [4,10]. Both the time to maximum drug concentration (Tmax) and the checkpoint activation of pilsicainide are approximately 3h. Though the half-life of pilsicainide is prolonged in cases of renal dysfunction, since it is a renally excreted drug [11], renal dysfunction was not observed in our patient. In fact, given that the blood concentration of pilsicainide 3h after re-administration in our case was 0.39µg/ml, we do not consider that the pilsicainide concentration was sufficiently high to induce the serious cardiac suppression [12]. In addition, we could not detect any sodium channel abnormalities. An effect of digoxin was considered as one of the possible causes of bradycardia. However, because the heart rate dropped within a short time after pilsicainide administration, while about 3h had passed since digoxin had been injected, digoxin may not have played an important role in the bradycardia. Some negative inotropic effects of propranolol might have been involved, as the pilsicainide was administered about 12h after the injection of propranolol. However, since the half-life of propranolol is 2.3h, we consider that the role of the injected propranolol would have been limited if any.
    Disclosures
    Conflict of interest
    Introduction
    Case report Analysis of the data in the pacemaker memory in December 2011 did not indicate any malfunction and showed that approximately 8000 premature ventricular beats (PVBs) and non-sustained ventricular tachycardia (NSVT) were occurring daily (Fig. 1). According to the patient\'s diary, the episodes of NSVT and PVBs coincided with his symptoms. Furthermore, the results of 24-h Holter monitoring corresponded with the pacemaker data. At this time, his body mass index (BMI) was 26. The patient refused to undergo any interventional procedures (e.g. angiography or an electrophysiologic study) to evaluate the status of his coronary artery disease and to assess the possible need for upgrading his ICD. According to current guidelines [1] and in view of his poor dietary intake of polyunsaturated fatty acids (PUFAs), he agreed to add an omega-3 fatty acid ethyl ester supplement (Omacor, known as Lovaza in the US [1g/day], Abbott Russia LLC) to his treatment regimen. Since he began taking omega-3 fatty acid ethyl ester supplementation, the patient has remained well. At a follow-up review in of June 2012, he confirmed that he continues to be physically active and to enjoy hunting. He currently takes Omacor (1g/day), statins, and aspirin, but he refuses to take beta blockers and ACE inhibitors. Importantly, he has experienced no further episodes of ventricular arrhythmias (Fig. 2); therefore, radiofrequency ablation or ICD placement has not yet been required.
    Discussion Fish oil derivatives may protect against sudden cardiac death [2]. The Gruppo Italiano per lo Studio della Sopravvivenza nell\'Infarto Miocardico (GISSI-Prevention) Study of 11,324 patients who had survived a recent MI demonstrated a highly significant (45%) reduction in risk of sudden cardiac death in the group that received omega-3 fatty acid ethyl ester supplementation with Omacor [3]. The reduction in the rate of death caused by cardiac events was significant by month 4 (p=0.048) [4]. The effect of high-dose omega-3 fatty acids has been examined in 3 randomized controlled trials that focused specifically on ventricular arrhythmias in patients with ICDs for secondary prevention of MI [5–7]. The results of these 3 studies were inconsistent. The Study on Omega-3 Fatty Acids and Ventricular Arrhythmia (SOFA; n=546) reported a non-significant trend toward event-free survival in a subgroup with prior MI randomized to 2g of fish oil per day (Table 1) [5,8]. In the Fatty Acid Antiarrhythmia Trial (FAAT; n=402), the use of omega-3 fatty acids was associated with a significant extension (33%) of the time until the first use of ICD or death [6]. However, the third trial of 200 patients who received an ICD because of sustained ventricular tachycardia or ventricular fibrillation (and not after an MI) failed to show a reduction in episodes of ventricular tachyarrhythmia after routine supplementation with omega-3 fatty acids [7]. As suggested by the authors of a recent meta-analysis, the discrepancies in results among these 3 trials may be due to the use of different antiarrhythmic medications and/or due to the different interactions of these antiarrhythmic drugs with the omega-3 fatty acids. There was also heterogeneity among the study populations [9].