Emergency Treatment With Nifekalant, a Novel Class III Anti-Arrhythmic Agent, for Life-Threatening Refractory Ventricular Tachyarrhythmias  Post-Marketing Special Investigation

Katoh, Takao; Mitamura, Hideo; Matsuda, Naoki; Takano, Teruo; Ogawa, Satoshi; Kasanuki, Hiroshi

doi:10.1253/circj.69.1237

Cited by 52 publications

(34 citation statements)

References 9 publications

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“…It is difficult to use a drug that takes time until the onset of its effect, 16 such as AMD, in the emergency care of patients suffering frequent episodes of VT/VF, namely, an electrical storm. Drugs with pharmacological effects like those of NIF are easier to use.…”

Section: Discussionmentioning

confidence: 99%

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

Yusu

Ikeda

Mera

et al. 2009

Circ J

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Background: Intravenous amiodarone (AMD) has been used for the treatment of ventricular tachycardia/fibrillation (VT/VF) in emergency care medicine. However, AMD acts slowly and is occasionally accompanied by hypotension and bradycardia. The antiarrhythmic effect of intravenous nifekalant (NIF) was assessed in patients with VT/VF complicating acute coronary syndrome (ACS) according to our study protocol. Methods and Results: Among a series of 1,143 ACS patients, 41 patients who suffered sustained VT/VF were enrolled; 19 failed to respond to a preceding lidocaine (LID) injection. NIF was given first as an intravenous bolus injection (0.2 mg/kg) and then as a continuous intravenous infusion at a relatively low dose level (0.2 mg · kg -1 · h -1 ). Sustained VT/VF was successfully inhibited by NIF in 34 patients (83%). In subgroup analysis, NIF achieved VT/VF inhibition in 79% of patients who received preceding LID and in 86% of patients who received direct NIF. There were no significant changes in systolic blood pressure or heart rate following NIF therapy. A corrected QT interval was significantly prolonged (P<0.01), whereas torsade de pointes developed in only 1 patient (2%). Conclusions: An intravenous bolus injection and subsequent continuous infusion of NIF at a relatively low dosage were effective in treating severe ventricular tachyarrhythmias complicating ACS, reducing the potential risk of proarrhythmia. (Circ J 2009; 73: 2021 -2028

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Section: Discussionmentioning

confidence: 99%

“…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. 13,16 Its use in the treatment of arrhythmias in ACS patients is thus limited.…”

mentioning

confidence: 99%

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

Yusu

Ikeda

Mera

et al. 2009

Circ J

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“…10 Several studies have reported that nifekalant is effective for the management of ventricular arrhythmias refractory to treatment with other drugs. 11,12 Nifekalant is expected to be an effective adjunctive treatment for refractory ventricular fibrillation, but this remains to be confirmed clinically. We retrospectively compared intravenous nifekalant with intravenous lidocaine in patients who had refractory ventricular fibrillation with no return of spontaneous circulation after 3 shocks from an external defibrillator, as recommended by the 2000 AHA guidelines.…”

mentioning

confidence: 99%

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

Terada

Kimura

Kosuge

et al. 2006

Circ J

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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)

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“…Nifekalant was administered at an initial dose of 0.3 mg· kg -1 ·(5 min) -1 , followed by infusion at 0.4 mg·kg -1 ·h -1 with careful ECG monitoring because of the risk of torsade de pointes. 13 Programmed electrical stimulation was repeated with the same protocol and endpoint as described before. Patients in whom VTA became non-inducible were defined as responders to nifekalant.…”

Section: Nifekalant Administrationmentioning

confidence: 99%

“…After nifekalant administration, VTA was not induced in 5 patients ( Table 2, patients 1-5), whereas VTA remained inducible without isoproterenol in the remaining 9 patients (patients [6][7][8][9][10][11][12][13][14]. The clinical characteristics of the responders and non-responders to nifekalant did not differ (Table 3).…”

Section: Efficacy Of Nifekalant For Inducible Vtamentioning

confidence: 99%

Comparison of Efficacy of Sotalol and Nifekalant for Ventricular Tachyarrhythmias

Watanabe

Chinushi

Washizuka

et al. 2006

Circ J

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Emergency Treatment With Nifekalant, a Novel Class III Anti-Arrhythmic Agent, for Life-Threatening Refractory Ventricular Tachyarrhythmias Post-Marketing Special Investigation

Cited by 52 publications

References 9 publications

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

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

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

Comparison of Efficacy of Sotalol and Nifekalant for Ventricular Tachyarrhythmias

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