Emergency treatment with nifekalant, a novel class III anti-arrhythmic agent, for life-threatening refractory ventricular tachyarrhythmias - Post-marketing special investigation
Emergency treatment with nifekalant, a novel class III anti-arrhythmic agent, for life-threatening refractory ventricular tachyarrhythmias - Post-marketing special investigation
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DOI：
10.1253/circj.69.1237
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发表时间：
2005-10-01
影响因子：
3.3
通讯作者：
Kasanuki, H
中科院分区：
文献类型：
--
作者：
Katoh, T;Mitamura, H;Kasanuki, H
背景：由于I类抗心律失常药物有时会抑制其负性肌力作用所引起的心功能，它们不适合于严重心力衰竭患者，甚至不适合于危及生命的室性快速性心律失常(室性心动过速/室颤)的紧急治疗。方法与结果客观评价委员会重新评估了191例难治性室速/室颤患者的硝苯卡兰的疗效。93例患者中有45例(48.4%)达到了发作终止。39例直流电抗休克VT/VF患者应用硝苯卡兰治疗，9例VT/VF患者直接终止VT/VF。在其余29名患者中，有15名患者(51.7%)在应用硝苯卡兰后，通过额外的直流电击成功地转复了室速/室颤。99例患者中有60例预防复发(60.6%)。首次应用硝苯卡兰后校正QT间期显著延长(0.463+/-0.056~0.504+/-0.072)，维持期校正QT间期显著延长(0.470+/-0.056~0.547+/-0.070)。不良反应：11例QT间期过度延长，其中3例伴有尖端扭矩。结论维持性输注硝苯卡兰治疗危及生命的顽固性室性快速性心律失常是有效的，但需仔细观察QT间期。
Background Because class I anti-arrhythmic drugs sometimes suppress cardiac function caused by their negative inotropic effects, they are not adequate for use in patients with severe heart failure, even as emergency treatment for life-threatening ventricular tachyarrhythmias (ventricular tachycardia (VT)/ventricular fibrillation (VF)).Methods and Results An objective evaluation committee re-evaluated the effect of nifekalant in 191 patients with refractory VT/VF. The attack termination was achieved in 45 out of 93 patients (48.4%). Nifekalant was administered to 39 patients with direct-current (DC) shock-resistant VT/VF and directly terminated VT/VF in 9 patients. In 15 of the remaining 29 patients (51.7%), VT/VF was successfully cardioverted by additional DC shock after nifekalant administration. Prevention of recurrence was achieved in 60 out of 99 patients (60.6%). Corrected QT interval (QTc) was significantly prolonged after initial administration of nifekalant (0.463 +/- 0.056 to 0.504 +/- 0.072), and during maintenance infusion (0.470 +/- 0.056 to 0.547 +/- 0.070). As an adverse reaction, excess prolongation of QTc was noted in 11 patients including 3 patients with torsades de pointes. Hemodynamic parameters tended to improve after maintenance infusion of nifekalant.Conclusion Nifekalant is effective and useful for life-threatening refractory ventricular tachyarrhythmias, although careful observation of the QT interval is required.