Case report: An autopsy case of pilsicainide poisoning.

We present a fatal case of pilsicainide poisoning. Quantitative toxicological analysis revealed that the concentrations of pilsicainide in femoral blood and urine samples were 17.5 µg/mL and 136.9 µg/mL, respectively. No morphological changes due to poisoning were observed. Based on the autopsy findings, results of the toxicological examination, and investigation by the authorities, we concluded that the cause of death was due to pilsicainide poisoning.

Determination of the novel antiarrhythmic drug sulcardine sulfate in human plasma by liquid chromatography tandem mass spectrometry and its application in a clinical pharmacokinetic study.

Sulcardine sulfate (Sul), a novel antiarrhythmic agent, is currently in phase I and phase II clinical trials. To elucidate its clinical pharmacokinetic characteristics, a rapid and accurate liquid chromatography-tandem mass spectrometry (LC-MS/MS) method has been developed and validated for the quantification of Sul in human plasma. Plasma samples were precipitated by acetonitrile and isotope-labeled sulcardine was added as internal standard. The analysis was carried out on a Capcell Pak C18 MG III column (100 × 2.0 mm, 5 µm) with 0.1% formic acid in acetonitrile solution and water (17:83, v/v) as mobile phase. The linear range was 5.0-1000 ng/mL for Sul, with a lower limit of quantification of 5.0 ng/mL. The intra- and inter-batch CVs were within ±11.0% and the accuracies were 4.9-107.3%. Our method, for the first time, allows the rapid (only 3.0 min) and accurate quantification of Sul in human plasma. The method has been successfully applied in the pharmacokinetic study of Sul in a clinical trial following oral administration of Sul to healthy volunteers. Copyright © 2016 John Wiley & Sons, Ltd.

Baseline characteristics and management of patients with atrial fibrillation/flutter in the emergency department: results of a prospective, multicentre registry in China.

BACKGROUND/AIM: There have been several studies of atrial fibrillation (AF) over the past decades; however, data from Chinese patients are scarce. The aim of the study was therefore to describe the patient characteristics, risk profile and management strategies for Chinese AF patients presenting to emergency department (ED). METHODS: We conducted a prospective, multicentre registry of patients with AF or atrial flutter (AFL) in China. Participants were enrolled at 20 EDs, then data regarding baseline characteristics and treatment in EDs were collected. RESULTS: Of the 2016 Chinese patients, 1104 (54.8%) were female. Six hundred eighteen (30.7%) had paroxysmal AF, 452 (22.4%) had persistent AF and 945 (46.9%) had permanent AF. The most common comorbidity was hypertension (55.5%), followed by coronary artery disease (41.8%) and heart failure (HF, 37.4%). The prevalence of concomitant cardiovascular risk factors, such as HF and valvular heart disease, increased as AF progressed. Among the patients with non-valvular AF, 110 (12.7%) of those with CHADS2 (congestive HF, hypertension, age of 75 years and greater, diabetes mellitus and history of stroke) ≥2 were prescribed oral anticoagulants (OAC), while 119 (15.6%) of those with CHADS2 <2 received such agents. Among the 324 patients with valvular AF, 134 (41.4%) actually were treated with OAC. The international normalised ratio value was within the target range (2.0-3.0) in 96 patients only (26.4%). Moreover, a total of 16.2% of the patients received ≥1 anti-arrhythmic agents, whereas rate control agents were used more frequently (68.4%). CONCLUSIONS: According to the present study, the risk profile and management of Chinese patients with AF/AFL differed from that observed in previous studies. The use of OAC inadequately deviate from current guidelines.

A importância do reconhecimento precoce da toxicidade pulmonar por amiodarona: a propósito de cinco casos / The importance of early recognizing of pulmonary toxicity by amiodarone: a report of five cases

Amiodarona é um agente antiarrítmico, com reconhecida toxicidade para os pulmões. Tal efeito adverso é geralmente relacionado à dose utilizada e duração da terapia, embora existam relatos de que esses não são os únicos preditores da toxicidade. A partir do atendimento, em um curto intervalo de tempo, de cinco pacientes com toxicidade pulmonar por amiodarona no Serviço de Pneumologia do Hospital São Lucas da PUCRS são revisados os critérios clínicos e diagnósticos de tal situação. Conclui-se pela conveniência de alto índice de suspeição clínica de avaliação, em todos os pacientes em uso da droga, da função pulmonar completa, inclusive com difusão pelo monóxido de carbono. A realização de espirometria convencional e gasometria arterial são úteis somente em casos avançados (AU)

Amiodarone is a commonly used anti-arrhythmic agent, with well-recognized lung toxicity. Such adverse effect is usually related to the dose and duration of the treatment, although there are reports showing that these are not the only predictors of toxicity. Following the occurrence of five cases diagnosed in a short period of time at the Serviço de Pneumologia do Hospital São Lucas da PUCRS, we reviewed clinical criteria and diagnostic procedures to assess such clinical situation. We conclude that is necessary a high clinical suspicion rate and for the need of pulmonary function evaluation, including carbon monoxide diffusion capacity, in all patients using the drug. Spirometry and arterial blood gases are useful only in severe cases (AU)