Efficacy of Nifekalant Hydrochloride in the Treatment of Fatal Ventricular Arrhythmia in Patients With Ischemic Heart Disease

Ando, Jiro; Kakishita, Mikio; Sakai, Koyu; Komura, Yasuo; Nishiyama, Kei; Iwabuchi, Masashi; Yokoi, Hiroyoshi; Yasumoto, Hitoshi; Nosaka, Hideyuki; Nobuyoshi, Masakiyo

doi:10.1536/ihj.46.647

Cited by 11 publications

(15 citation statements)

References 21 publications

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“…Two retrospective control studies (LOE 3), 357,358 1 case series (LOE 4), 359 and 1 other study (LOE 5) 360 suggested that nifekalant improved outcome in patients with shock refractory VF/VT, even though it did not seem to be effective in immediately terminating the arrhythmia. 359 Preventing recurrence and late conversion in refractory ventricular tachyarrhythmias including mVT: Amiodarone Two RCTs (LOE 1) comparing amiodarone with lidocaine 340 or bretylium, 361 2 double-blind randomized doserange studies (LOE 4), 362,363 and 5 case series (LOE 4) 364 -368 suggested that amiodarone reduced the number of life-threatening arrhythmias (event rate), required shocks, and episodes of symptomatic sustained VT that occurred in patients with recurrent refractory ventricular arrhythmias in hospital.…”

Section: Nifekalantmentioning

confidence: 99%

Part 8: Advanced Life Support

Morrison¹,

Deakin²,

Morley³

et al. 2010

Circulation

411

169

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Section: Nifekalantmentioning

confidence: 99%

Part 8: Advanced Life Support

Morrison¹,

Deakin²,

Morley³

et al. 2010

Circulation

411

169

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Section: Methodsmentioning

confidence: 99%

“…Nifekalant was used for VT/VF interruption or defibrillation enhancement 4) for continuous VT/VF, and it was used for VT/VF prevention or maintenance of sinus rhythm for recurrent VT/VF. 4) Nifekalant was administered at an initial dose of 0.1-0.4 mg/kg over 5 minutes, and it was followed by a continuous infusion at a dose of 0.4 mg/kg/h when necessary for maintaining sinus rhythm in the patients with effective results. 4,7) The efficacy of nifekalant was considered as effective when one of the following findings was obtained after the initial infusion of nifekalant, i.e., 1) interruption of lidocaine refractory VT/VF, 2) change in the DC cardioversion results from being non-effective to effective for lidocaine refractory VT/VF, or 3) prevention of any repetitive lidocaine refractory VT/VF.…”

Section: Methodsmentioning

confidence: 99%

“…3) Prior to that time, we had considerable experience administering nifekalant, a pure Ikr channel blocker, as the only class III antiarrhythmic agent available for intravenous injections in Japan for the management of refractory ventricular arrhythmias. [4][5][6] Although we sometimes experienced patients with life-threatening arrhythmias in whom nifekalant exhibits dramatic efficacy, the incidence and patient characteristics of nifekalant as a treatment modality remains unclear. In the present study, we evaluated the efficacy of nifekelant on refractory ventricular arrhythmias and also evaluated the clinical characteristics of the patients with effective or non-effective results with nifekalant usage in order to clarify the clinical usefulness of nifekalant in managing refractory arrhythmias.…”

Section: Introductionmentioning

confidence: 99%

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Effect of nifekalant on life-threatening ventricular arrhythmias in patients with cardiopulmonary resuscitation or during the perioperative state

et al. 2008

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Background: Nifekalant is a unique class III anti-arrhythmic agent with a strong effect on prolonging the myocardial refractoriness, but its clinical effect is still unclear. In this study, we evaluated the effect of nifekalant on life-threatening ventricular arrhythmias and compared the clinical background between the effective and non-effective patients in order to clarify the clinical factors which may have an influence on the efficacy of nifekalant.Methods: The study population consisted of 47 consecutive patients who underwent nifekalant administration for life-threatening ventricular arrhythmias (VT/VF). Their clinical characteristics and ECG parameters were retrospectively compared between patients with and without an effective result with the nifekalant administration.Results: Nifekalant was effective for refractory VT/VF in 26/47 patients. There was no significant difference in the age, gender or left ventricular ejection fraction, but the incidence of ischemic heart disease was higher in the effective group (17/26) than non-effective group (9/21, p ¼ 0:004). The incidence of in-hospital events was higher in the effective group than non-effective group (20/26 vs 10/21, p ¼ 0:037). A significant prolongation in the QTc interval was observed in all patients and the degree of QTc prolongation was greater in the effective group than in the non-effective group (0:46 AE 0:04 vs 0:43 AE 0:02 sec 1=2 , p ¼ 0:026).Conclusion: Nifekalant was effective in 55% of the patients for refractory VT/VF. It was considered that nifekalant was more effective for patients with ischemic heart disease, during the perioperative period or in those experiencing in-hospital events. The prolongation of the QTc interval might also be useful as an index for the efficacy of nifekelant administration. (J Arrhythmia 2008; 24: 141-148)

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“…The heart was cannulated through the aorta and perfused with Krebs-Henseleit solution maintained at 37°C ± 0.5°C and aerated with a mixture of O 2 (95%) and CO 2 (5%) at a pressure of approximately 60 mmHg and a flow rate of 20 to 30 mL/min by using a Langendorff system (Physio-Tech, Tokyo). The Krebs-Henseleit solution contained 118 mM NaCl, 4.7 mM KCl, 11.0 mM glucose, 25 mM NaHCO 3 , 1.2 mM MgSO 4 , 2.5 mM CaCl 2 , and 1.2 mM KH 2 PO 4 .…”

Section: Preparation Of Langendorff Heart Model Of Guinea Pigs and Pementioning

confidence: 99%

Effects of pH on Nifekalant-Induced Electrophysiological Change Assessed in the Langendorff Heart Model of Guinea Pigs

et al. 2014

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Abstract. Since information regarding the effects of pH on the extent of nifekalant-induced repolarization delay and torsades de pointes remains limited, we assessed it with a Langendorff heart model of guinea pigs. First, we investigated the effects of pH change from 7.4 to 6.4 on the bipolar electrogram simulating surface lead II ECG, monophasic action potential (MAP), effective refractory period (ERP), and terminal repolarization period (TRP) and found that acidic condition transiently enhanced the ventricular repolarization. Next, we investigated the effects of pH change from 6.4 to 7.4 in the presence of nifekalant (10 mM) on the ECG, MAP, ERP, TRP, and short-term variability (STV) of MAP 90 and found that the normalization of pH prolonged the MAP 90 and ERP while the TRP remained unchanged, suggesting the increase in electrical vulnerability of the ventricle. Meanwhile, the STV of MAP 90 was the largest at pH 6.4 in the presence of nifekalant, indicating the increase in temporal dispersion of repolarization, which gradually decreased with the return of pH to 7.4. Thus, a recovery period from acidosis might be more dangerous than during the acidosis, because electrical vulnerability may significantly increase for this period while temporal dispersion of repolarization remained increased.

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Efficacy of Nifekalant Hydrochloride in the Treatment of Fatal Ventricular Arrhythmia in Patients With Ischemic Heart Disease

Cited by 11 publications

References 21 publications

Part 8: Advanced Life Support

Part 8: Advanced Life Support

Effect of nifekalant on life-threatening ventricular arrhythmias in patients with cardiopulmonary resuscitation or during the perioperative state

Effects of pH on Nifekalant-Induced Electrophysiological Change Assessed in the Langendorff Heart Model of Guinea Pigs

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