Experience With Nifekalant Hydrochloride in a Patient With Ischemic Cardiomyopathy and Severe Ventricular Dysfunction After Dor Operation

Abstract

SUMMARYA 52-year-old male with ischemic cardiomyopathy and severe ventricular dysfunction underwent coronary artery bypass grafting and left ventricular reconstruction (Dor operation). The patient developed acute onset of incessant ventricular tachycardia in the early postoperative period that was refractory to therapy with class I antiarrhythmic agents, and multiple attempts at electrical cardioversion were required. A combination of intravenous nifekalant hydrochloride and enteral amiodarone was elected as treatment for this recurrent incessant ventricular tachycardia. Nifekalant hydrochloride was administered as a loading dose (0.3 mg/kg/5 min), followed by an intravenous infusion (0.4 mg/kg/hr). Several days after initiating therapy, the patient no longer experienced episodes of ventricular tachycardia, and there was no compromise in hemodynamics. We conclude that nifekalant hydrochloride is a useful agent for suppression of ventricular tachycardia in patients with severe left ventricular dysfunction, especially during the early postoperative period. (Jpn Heart J 2004; 45: 691-695) Key words: Nifekalant hydrochloride, Dor operation, Ischemic cardiomyopathy, Incessant ventricular tachycardia VENTRICULAR tachycardia (VT) is a potentially fatal complication that can occur after a Dor operation when employed for patients with ischemic cardiomyopathy and severe left ventricular dysfunction. We describe a case of incessant VT after Dor operation that was successfully treated with nifekalant hydrochloride (NIF). CASE REPORTA 52-year-old male with orthopnea was diagnosed with severe heart failure (NYHA class IV) and was admitted to our hospital for further evaluation and

Refractory ventricular arrhythmias during aortic valve replacement and cardiac artery bypass requiring 16 attempts of electrical cardioversion: a case report

“…Although some studies [ 2 , 3 ] show that nifekalant is not inferior to amiodarone in managing patients with fatal ventricular arrhythmias, only a few large-scale studies have compared the efficacy of the two drugs. In fact, a couple of similar case reports published in Japan have described that the majority of VF cases had occurred during coronary reperfusion therapy [ 6 ] and in patients undergoing bypass surgery [ 7 , 8 ].…”

Can Nifekalant Hydrochloride be Used as a First-Line Drug for Cardiopulmonary Arrest (CPA)?

“…[14][15][16] The only disadvantage of NIF is very prolonged QT intervals, especially with bradycardia under the conditions of reverse use dependent block, 8 and there is a risk of torsades de pointes (Tdp). 17 There have been many reports of the efficacy of NIF for ischemic heart disease (IHD) after the Dor operation [18][19] and in patients undergoing hemodialysis. 20 NIF is also effective for ventricular arrhythmia when there is severe ventricular dysfunction.…”