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A single oral dose of pilsicainide, a class 1c antiarrhythmic drug, is effective in terminating acute-onset atrial fibrillation (AF), but its effect on pacing thresholds in pacemaker patients is unknown. The present study measured atrial and ventricular pacing thresholds after a single oral dose of pilsicainide in patients with and without AF. Twelve patients with dual-chamber pacemakers were evaluated. Pacing thresholds as well as plasma pilsicainide concentration were measured prior to and then at 30, 60, 90, 120 and 180 min and 24h following a single oral dose of pilsicainide (150 mg). Six patients had paroxysmal AF and the remaining 6 did not. Pacing thresholds increased significantly (134+/-8%) in the atrium (p&lt;0.05) and in the ventricle (155+/-11%; p&lt;0.001) following pilsicainide administration in all 12 patients. Plasma concentrations of pilsicainide showed a positive liner correlation with pacing thresholds (R=0.62, p&lt;0.0001 in the atrium; R=0.74, p&lt;0.0001 in the ventricle). Atrial pacing thresholds in the patients with AF showed a significant increase at 90, 120 and 180 min compared with the patients without AF (p&lt;0.05). There was no significant difference in either the ventricular pacing threshold or the plasma pilsicainide concentration in the patients with and without AF. It was concluded that a single oral dose of pilsicainide increases the pacing thresholds in both the atrium and ventricle in a selected group of pacemaker-implanted patients; that is, those who are aged and with AF. Thus, careful attention should be paid to pacemaker-dependent patients, particularly those with paroxysmal AF, when administering pilsicainide.

Effect of a Single Oral Dose of Pilsicainide on Pacing Thresholds in Pacemaker Patients With and Without Paroxysmal Atrial Fibrillation