A Survived Case of WPW Syndrome, Against Which Continuous Administration of Procainamide Was Effective

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Case: 54-year-old male. Previous Illnesses: WPW syndrome. Present Illness: The patient suddenly collapsed on a street in cardiopulmonary arrest. As return of spontaneous circulation could be obtained, the patient was transferred to our hospital. Following admission to the ICU, the patient frequently exhibited tachycardial arrhythmia. Cardioversion at 100 J using ECG gating and intravenous injection of pilsicainide were ineffective, and there was no response to disopyramide. Only continuous intravenous infusion of procainamide was effective. Procainamide was subsequently injected initially at 500mg followed by maintaining at 300mg/hr, after which the tachycardia subsided. Blood procainamide concentrations were found to be suitably maintained and there were no adverse side effects observed. After the patient's level of consciousness improved, catheter ablasion was performed at another hospital after which the patient was able to return to society. The recommended approach for the treatment of tachycardia in the Guideline 2000 basically consists of the implementation of cardioversion. In this case, only procainamide was effective, it was administered by continuous intravenous infusion. Continuous intravenous infusion of procainamide may be a possible candidate for such treatment as a kind of bridge until curative treatment.
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