经体外膜氧合和经皮腔内心肌消融术成功治疗肥厚性梗阻性心肌病的严重苯并啉中毒1例报告

Q4 Medicine

Journal of Cardiology Cases Pub Date : 2025-06-01 DOI:10.1016/j.jccase.2025.02.006

Hiroto Yagasaki MD , Takeki Suzuki MD, MPH, PhD , Keitaro Watanabe MD , Shunichiro Warita MD, PhD , Makoto Iwama MD, PhD , Toshiyuki Noda MD, PhD, FJCC

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引用次数: 0

摘要

Cibenzoline （CBZ）是一类抗心律失常药物，用于肥厚性梗阻性心肌病（HOCM）患者。然而，需要仔细监测肾功能不全患者的潜在毒性。我们报告一例严重的CBZ毒性的72岁女性HOCM，既往升主动脉夹层修复，肾功能不全。尽管肾功能波动，仍维持每日cbz300 毫克。她表现出急性呼吸窘迫。在就诊时，发现患者心动过缓，QRS延长（340 ms）， CBZ水平明显升高（1973 ng/mL，治疗范围：200-800 ng/mL）。她在急诊室突发心脏骤停。心脏骤停后，开始静脉-体外膜氧合（VA-ECMO）。直接血液灌流使CBZ水平降低最小。随着尿量的增加，CBZ水平恢复正常，并伴有心电图改善。VA-ECMO退出后，经皮腔内室间隔心肌消融（PTSMA）作为消除CBZ依赖的最终治疗。本病例说明了HOCM、肾损害和CBZ毒性之间复杂的相互作用，强调了肾损害患者仔细监测药物的重要性。此外，它证明了PTSMA作为HOCM患者在药物相关并发症高风险的最终治疗的潜在作用。•了解苯并啉的药代动力学及其对老年肥厚性阻塞性心肌病（HOCM）和肾功能受损患者监测的必要性。•认识苯并啉毒性的机制及其急性管理策略，包括机械循环支持和直接血液灌流。•确定HOCM患者药物治疗引起的并发症的急性管理策略和长期治疗方案。

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Severe cibenzoline toxicity in hypertrophic obstructive cardiomyopathy successfully managed with extracorporeal membrane oxygenation and percutaneous transluminal septal myocardial ablation — A case report

Cibenzoline (CBZ), a class I antiarrhythmic drug, is used for patients with hypertrophic obstructive cardiomyopathy (HOCM). However, it requires careful monitoring in patients with renal dysfunction for potential toxicity. We present a case of severe CBZ toxicity in a 72-year-old woman with HOCM, previous ascending aortic dissection repair, and renal dysfunction. She was maintained on CBZ 300 mg daily despite fluctuating renal function. She presented with acute respiratory distress. On presentation, she was found to have bradycardia with QRS prolongation (340 ms) and markedly elevated CBZ levels (1973 ng/mL, therapeutic range: 200–800 ng/mL). She developed sudden cardiac arrest in the emergency room. Following cardiac arrest, venoarterial extracorporeal membrane oxygenation (VA-ECMO) was initiated. Direct hemoperfusion yielded minimal reduction in CBZ levels. With increased urine output, CBZ levels normalized, accompanied by electrocardiographic improvement. After VA-ECMO withdrawal, percutaneous transluminal septal myocardial ablation (PTSMA) was performed as definitive treatment to eliminate CBZ dependency. This case illustrates the complex interaction between HOCM, renal impairment, and CBZ toxicity, emphasizing the importance of careful drug monitoring in patients with renal impairment. Additionally, it demonstrates the potential role of PTSMA as a definitive treatment for selected patients with HOCM at high risk of medication-related complications.

Learning objectives

•
Understand the pharmacokinetics of cibenzoline and its need for monitoring in elderly patients with hypertrophic obstructive cardiomyopathy (HOCM) and impaired renal function.
•
Recognize the mechanisms of cibenzoline toxicity and its acute management strategies, including mechanical circulatory support and direct hemoperfusion.
•
Identify the acute management strategies and long-term treatment options for complications arising from medical therapy in patients with HOCM.

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