Key result
Low-dose pilsicainide suppresses atrial arrhythmias and facilitates slow-fast AVNRT by prolonging antegrade slow pathway conduction.
Why the study?
The specific impact of low-dose pilsicainide on AV nodal slow pathway conduction and AVNRT sustainability remains unclear.
Case Report (n=1)
Low-dose pilsicainide may facilitate the induction of sustained slow-fast AVNRT during electrophysiological studies by selectively prolonging antegrade slow pathway conduction while suppressing atrial fibrillation.
May facilitate AVNRT induction in select EP cases; single-case observation leaves open broader applicability.
BACKGROUND: Although pilsicainide has concentration-dependent effects on cardiac conduction, its specific impact-particularly at low doses-on atrioventricular (AV) nodal slow pathway conduction and atrioventricular nodal re-entrant tachycardia (AVNRT) sustainability remains unclear. CASE SUMMARY: A 74-year-old woman presented with narrow-QRS tachycardia. During electrophysiological study, atrial extrastimulation induced an atrio-His interval jump and a single echo beat, but repeatedly triggered atrial fibrillation requiring cardioversion. Low-dose pilsicainide (20 mg) suppressed atrial arrhythmias but markedly prolonged antegrade slow pathway conduction, rendering sustained tachycardia inducible. Entrainment and His-refractory ventricular extrastimulation confirmed slow-fast AVNRT, which was successfully treated with slow pathway ablation. DISCUSSION: Low-dose pilsicainide may facilitate sustained slow-fast AVNRT by disproportionately prolonging antegrade slow pathway conduction, thereby promoting reentry. Marked atrio-His interval prolongation relative to atrial conduction delay, alongside an unchanged ventriculo-atrial interval, supports a selective antegrade slow pathway mechanism.
No takes yet. Share an insight, caveat, or question.
Nakata et al. (2026) conducted a case report in Narrow-QRS tachycardia (n=1). Low-dose pilsicainide was evaluated on Suppression of atrial arrhythmias and induction of sustained tachycardia. Low-dose pilsicainide (20 mg) suppressed atrial arrhythmias and facilitated sustained slow-fast AVNRT by prolonging antegrade slow pathway conduction.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: