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

Abstract

Background: We report a patient in whom we failed to suppress ventricular fibrillation (VF) using nifekalant but succeeded using amiodarone during cardiopulmonary bypass (CPB). Case presentation: A 65-year-old male with hemodialysis complained of dyspnea and was diagnosed with aortic valve stenosis and angina pectoris; he was opted for elective aortic valve replacement. When the aortic forceps were declamped during CPB, immediate VF was observed; several attempts of electrical cardioversion (EC) with lidocaine and landiolol and three administrations of nifekalant were temporarily effective. However, the rhythm subsequently changed to torsades de pointes. We administered 2 g of magnesium sulfate followed by three doses of amiodarone and initiated continuous infusion. Furthermore, we initiated the pacemaker and intra-aortic balloon pumping. These procedures seemed to be effective; the sinus rhythm was sustained until the end of the surgery. Conclusion: We experienced a cardiac surgery requiring 16 EC attempts to terminate the life-threatening arrhythmias using amiodarone.

Retrosternal hematoma causing torsade de pointes after coronary artery bypass graft surgery; a case report

“…A review of all cases (available in the literature) suggested cardiac surgery and craniotomies accounting for 40% of all cases with perioprative TdP ( 11 ). Reports suggest that TdP is probably not the direct effect of CABG, but related to CABG complications ( 12 – 14 ), such as ischemia (due to graft failure) ( 12 ) or co-administartion of Q-T prolonging drugs (like amiodarone) in the perioperative period ( 13 , 15 ). It is important to remember that prolonged QTc is multifactorial and can occur by genetic and inhertited causes, as well ( 14 ).…”

Coronary Artery Bypass Grafting for Refractory Ventricular fibrillation after the Release of the Aortic Cross-Clamp in Patients Undergoing Aortic Valve Replacement: A Case Report

“…Nifekalant is a potassium channel blocker available only in Japan and is often used in place of amiodarone to suppress signs of life-threatening arrhythmias such as VF and tachycardia. The advantage of nifekalant is that it is a pure potassium channel blocker, so it does not cause inotropic effects and has a shorter half-life than amiodarone [5]. In addition, warm blood perfusion is also a common method for VF after releasing the ACC.…”