The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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A Case of Life-Threatening Supraventricular Tachycardia Related to Flecainide Toxicity

Flecainide 독성과 관련된 치명적인 심실상빈맥의 1예

  • Cheon, Sang Soo (Division of Cardiology, Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Song, Joon Hyuk (Division of Cardiology, Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Bae, Myung Hwan (Division of Cardiology, Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Lee, Jang Hoon (Division of Cardiology, Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Yang, Dong Heon (Division of Cardiology, Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Park, Hun Sik (Division of Cardiology, Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Chae, Shung Chull (Division of Cardiology, Department of Internal Medicine, Kyungpook National University School of Medicine)
  • 천상수 (경북대학교 의학전문대학원 내과학교실 순환기내과) ;
  • 송준혁 (경북대학교 의학전문대학원 내과학교실 순환기내과) ;
  • 배명환 (경북대학교 의학전문대학원 내과학교실 순환기내과) ;
  • 이장훈 (경북대학교 의학전문대학원 내과학교실 순환기내과) ;
  • 양동헌 (경북대학교 의학전문대학원 내과학교실 순환기내과) ;
  • 박헌식 (경북대학교 의학전문대학원 내과학교실 순환기내과) ;
  • 채성철 (경북대학교 의학전문대학원 내과학교실 순환기내과)
  • Received : 2013.07.11
  • Accepted : 2013.08.13
  • Published : 2014.07.01
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Abstract

Flecainide acetate is a potent class Ic anti-arrhythmic drug with a major sodium channel-blocking effect. Flecainide toxicity can cause myocardial impairment and precipitate circulatory collapse, particularly in patients with renal failure. Electrical and hemodynamic deterioration during flecainide toxicity may not respond to conventional treatments. We report the successful management of flecainide toxicity using extracorporeal membrane oxygenation (ECMO), hemoperfusion, and bicarbonate administration maintaining alkalinity.

평소 말기 신부전으로 혈액투석을 받고 있는 72세 여자 환자가 폐렴에 의한 심부전의 악화로 입원하였으며 발작성 심방세동의 치료를 위해 flecainide 50 mg 하루 세 번이 투여되었다. 폐렴 및 심부전의 치료 후 회복되어 퇴원을 고려하던 중 flecainide 독성으로 인해 wide QRS complex 형태의 빈맥이 발생하였으며 불응성 심인성 쇼크로 진행하였다. 승압제 등 일반적인 치료로 심인성 쇼크 회복되지 않아 bicarbonate 정주하며 체외막 산소공급 및 혈액 관류 실시하였으며 환자는 합병증 없이 성공적으로 회복되어 퇴원하였다. 저자들은 말기신부전 환자에서 flecainide 독성으로 발생한 불응성 심인성 쇼크를 체외막 산소공급 및 혈액관류로 성공적으로 치료한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Keywords

References

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