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A case of Torsade de Pointes induced by N-acetyl procainamide Takashi Fujii 1 , Tohru Ohe 1 , Fujio Deguchi 1 , Katsuro Shimomura 1 , Keiichi Ito 1 1Department of Internal Medicine, National Cardiovascular Center pp.197-201
Published Date 1987/2/15
DOI https://doi.org/10.11477/mf.1404205011
  • Abstract
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The patient was a 57-year-old man with chronic renal failure due to amyloidosis.

He was admitted to the hospital for hemodialysis. As the patient had frequent episodes of short runs ofventricular tachycardia, procainamide (PA) (1.0g/day) was started. On 24th days after PA administration, he experienced frequent episodes of Torsade de Pointes (TdP) during hemodialysis.

Blood concentrations of PA and N-acetyl procainamide (NAPA), which is a major metabolic product of PA, were 4.6μg/ml and 41.5μg/ml respectively. The former was in the therapeutic level but the latter was in the toxic one.

QT interval (0.66 second) and QTc (0.68 second) were both markedly prolonged. PA was discontinued and lidocaine was started.

About 20 days later, blood concentration of PA and NAPA were decreased to 0μg/ml and 0.4μg/ml respe-ctively. At that time, QT interval and QTc were normalized.

The cause of TdP was considered to be the accumula-tion of NAPA due to chronic renal failure.

Prompt cessation of PA and lidocaine therapy were effective in this case.


Copyright © 1987, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1200 印刷版ISSN 0452-3458 医学書院

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