Comparison of Nifekalant and Lidocaine for the Treatment of Shock-Refractory Ventricular Fibrillation

Abstract

Background Although nifekalant is a class III antiarrhythmic agent without negative inotropic activity, its effect in patients with shock-refractory ventricular fibrillation remains unclear. Methods and ResultsPatients who had an out-of-hospital cardiac arrest with ventricular fibrillation that persisted after 3 shocks from an external defibrillator, intravenous epinephrine, and another shock were retrospectively studied. The patients received lidocaine from January 1997 through June 2001 and nifekalant from July 2001 through December 2004. Short-term survival rates (survival to hospital admission and 24-h survival) were compared between the groups. The study group comprised 120 patients (mean age: 62±16 years): 55 received nifekalant and 65 received lidocaine. Age, sex, history of ischemic heart disease, whether arrest was witnessed or not and time to arrival at the hospital did not differ significantly between the groups. As compared with lidocaine, nifekalant was associated with significantly higher rates of survival to hospital admission (67% vs 37%, p<0.001) and 24-h survival (53% vs 31%, p=0.01). Multivariate analysis showed that treatment with nifekalant and early initiation of cardiopulmonary resuscitation were independent predictors of 24-h survival. Conclusions As compared with lidocaine, nifekalant may improve short-term survival in patients with out-ofhospital cardiac arrest due to shock-refractory ventricular fibrillation. (Circ J 2006; 70: 442 -446)

Report From J-PULSE Multicenter Registry of Patients With Shock-Resistant Out-of-Hospital Cardiac Arrest Treated With Nifekalant Hydrochloride

“…6 However, there have been few single center studies regarding the effect of NIF on patients with shock-resistant, out-ofhospital VF. The rate of admission alive to the hospital was 67% (37 survivors of 55 patients treated with NIF), 15 which was comparable with the present results, where the data were collected from 4 established emergency departments. However, over 20 min spent until NIF was administered following the first shock.…”

Effects of Intravenous Nifekalant as a Lifesaving Drug for Severe Ventricular Tachyarrhythmias Complicating Acute Coronary Syndrome

“…Several studies have demonstrated the efficacy of NIF in arresting or controlling sustained VT/VF. [11][12][13][14][15] NIF is easy to use for the treatment of VT/VF, developing in association with ACS, because of its slight effects on hemodynamic status and the rapid onset of its beneficial effects. Unlike AMD, however, NIF selectively blocks IKr channels and eventually frequently causes QT interval prolongation during sinus rhythm, and might thus give rise to torsade de pointes (TdP) as a proarrhythmic effect.…”

Acute Myocardial Infarction The Enduring Challenge for Cardiac Protection and Survival

“…85 Compared with amiodarone, nifekalant hydrochloride has unique pharmacokinetics for rapid action and clearance, and has several advantageous characteristics, particularly for emergency care, including the improvement of the defibrillating threshold and minimal cardiac depressant effect. [86][87][88] In addition to a previous single center experience, 89 the recent multicenter registry study of Japanese Population-based Utstein-style study with basic and advanced Life Support Education (J-PULSE) demonstrated that nifekalant hydrochloride improved the survival rate of hospitalized patients compared with outof-hospital cardiac arrest to more than 70%. 90 Thus, intravenous administration of nifekalant hydrochloride seems to be feasible and can be adjunctive to advanced cardiac life support.…”