Use of intravenous amiodarone in the treatment of nifekalant-resistant arrhythmia

A review of 11 consecutive cases with severe heart failure

Koji Nakagawa, Kazufumi Nakamura, Kengo Fukushima Kusano, Satoshi Nagase, Takeshi Tada, Masato Murakami, Yoshiki Hata, Hiroshi Morita, Kunihisa Kohno, Kazumasa Hina, Tohru Ujihira, Tohru Ohe, Hiroshi Itoh

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Both nifekalant hydrochloride (NIF), a selective IKr blocker, and intravenous amiodarone (AMD), a multi-channel (including IKr blocking) blocker, have been reported to be efficacious for refractory arrhythmias. However, the optimal use of those antiarrhythmic drugs for refractory arrhythmia with severe heart failure has not been established. Intravenous AMD might be effective for arrhythmias refractory to NIF in patients with severe heart failure. Here, we report that intravenous amiodarone was effective in the treatment of nifekalant-resistant in a group of arrhythmia patients with severe heart failure. Methods: Eleven severe heart failure patients who had received intravenous AMD for treatment of NIF-resistant arrhythmias were included in this study, and retrospective analysis was performed. Clinical efficacy (terminative and preventive effects on arrhythmia) of intravenous AMD was evaluated. Results: All cases were emergent cases and had depressed left ventricular ejection fraction (30 ± 13%). Clinical arrhythmias were ventricular fibrillation (VF) in four patients, ventricular tachycardia (VT) in six patients, and atrial fibrillation (AF) in one patient. NIF was administered to all patients by intravenous injection. After administration of NIF, VT/VF/AF was terminated in seven of the 10 patients, but a preventive effect was not obtained in any of the patients (NIF-resistance). Intravenous AMD (maintenance dose: 484 ± 166 mg/day) was effective both in termination (80%) and in prevention (80%) of VT/VF events in those patients. It was also effective in termination (80%) and prevention (60%) of AF events refractory to NIF. During continuous AMD administration, no significant adverse effects or proarrhythmic effects were observed in any of the patients. Five patients died within one month, but there was no arrhythmic deaths. Conclusions: Intravenous AMD was effective in NIF-resistant lethal arrhythmias and was relatively safe in emergent cases with severe heart failure.

Original languageEnglish
Pages (from-to)794-803
Number of pages10
JournalPharmaceuticals
Volume4
Issue number6
DOIs
Publication statusPublished - 2011

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Amiodarone
Cardiac Arrhythmias
Heart Failure
Ventricular Fibrillation
Therapeutics
Ventricular Tachycardia
Atrial Fibrillation
nifekalant
Anti-Arrhythmia Agents
Intravenous Injections
Stroke Volume
Retrospective Studies

Keywords

  • Arrhythmias
  • Atrial fibrillation
  • Heart failure
  • Ventricular arrhythmia

ASJC Scopus subject areas

  • Molecular Medicine
  • Pharmaceutical Science

Cite this

Use of intravenous amiodarone in the treatment of nifekalant-resistant arrhythmia : A review of 11 consecutive cases with severe heart failure. / Nakagawa, Koji; Nakamura, Kazufumi; Kusano, Kengo Fukushima; Nagase, Satoshi; Tada, Takeshi; Murakami, Masato; Hata, Yoshiki; Morita, Hiroshi; Kohno, Kunihisa; Hina, Kazumasa; Ujihira, Tohru; Ohe, Tohru; Itoh, Hiroshi.

In: Pharmaceuticals, Vol. 4, No. 6, 2011, p. 794-803.

Research output: Contribution to journalArticle

Nakagawa, Koji ; Nakamura, Kazufumi ; Kusano, Kengo Fukushima ; Nagase, Satoshi ; Tada, Takeshi ; Murakami, Masato ; Hata, Yoshiki ; Morita, Hiroshi ; Kohno, Kunihisa ; Hina, Kazumasa ; Ujihira, Tohru ; Ohe, Tohru ; Itoh, Hiroshi. / Use of intravenous amiodarone in the treatment of nifekalant-resistant arrhythmia : A review of 11 consecutive cases with severe heart failure. In: Pharmaceuticals. 2011 ; Vol. 4, No. 6. pp. 794-803.
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abstract = "Background: Both nifekalant hydrochloride (NIF), a selective IKr blocker, and intravenous amiodarone (AMD), a multi-channel (including IKr blocking) blocker, have been reported to be efficacious for refractory arrhythmias. However, the optimal use of those antiarrhythmic drugs for refractory arrhythmia with severe heart failure has not been established. Intravenous AMD might be effective for arrhythmias refractory to NIF in patients with severe heart failure. Here, we report that intravenous amiodarone was effective in the treatment of nifekalant-resistant in a group of arrhythmia patients with severe heart failure. Methods: Eleven severe heart failure patients who had received intravenous AMD for treatment of NIF-resistant arrhythmias were included in this study, and retrospective analysis was performed. Clinical efficacy (terminative and preventive effects on arrhythmia) of intravenous AMD was evaluated. Results: All cases were emergent cases and had depressed left ventricular ejection fraction (30 ± 13{\%}). Clinical arrhythmias were ventricular fibrillation (VF) in four patients, ventricular tachycardia (VT) in six patients, and atrial fibrillation (AF) in one patient. NIF was administered to all patients by intravenous injection. After administration of NIF, VT/VF/AF was terminated in seven of the 10 patients, but a preventive effect was not obtained in any of the patients (NIF-resistance). Intravenous AMD (maintenance dose: 484 ± 166 mg/day) was effective both in termination (80{\%}) and in prevention (80{\%}) of VT/VF events in those patients. It was also effective in termination (80{\%}) and prevention (60{\%}) of AF events refractory to NIF. During continuous AMD administration, no significant adverse effects or proarrhythmic effects were observed in any of the patients. Five patients died within one month, but there was no arrhythmic deaths. Conclusions: Intravenous AMD was effective in NIF-resistant lethal arrhythmias and was relatively safe in emergent cases with severe heart failure.",
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T1 - Use of intravenous amiodarone in the treatment of nifekalant-resistant arrhythmia

T2 - A review of 11 consecutive cases with severe heart failure

AU - Nakagawa, Koji

AU - Nakamura, Kazufumi

AU - Kusano, Kengo Fukushima

AU - Nagase, Satoshi

AU - Tada, Takeshi

AU - Murakami, Masato

AU - Hata, Yoshiki

AU - Morita, Hiroshi

AU - Kohno, Kunihisa

AU - Hina, Kazumasa

AU - Ujihira, Tohru

AU - Ohe, Tohru

AU - Itoh, Hiroshi

PY - 2011

Y1 - 2011

N2 - Background: Both nifekalant hydrochloride (NIF), a selective IKr blocker, and intravenous amiodarone (AMD), a multi-channel (including IKr blocking) blocker, have been reported to be efficacious for refractory arrhythmias. However, the optimal use of those antiarrhythmic drugs for refractory arrhythmia with severe heart failure has not been established. Intravenous AMD might be effective for arrhythmias refractory to NIF in patients with severe heart failure. Here, we report that intravenous amiodarone was effective in the treatment of nifekalant-resistant in a group of arrhythmia patients with severe heart failure. Methods: Eleven severe heart failure patients who had received intravenous AMD for treatment of NIF-resistant arrhythmias were included in this study, and retrospective analysis was performed. Clinical efficacy (terminative and preventive effects on arrhythmia) of intravenous AMD was evaluated. Results: All cases were emergent cases and had depressed left ventricular ejection fraction (30 ± 13%). Clinical arrhythmias were ventricular fibrillation (VF) in four patients, ventricular tachycardia (VT) in six patients, and atrial fibrillation (AF) in one patient. NIF was administered to all patients by intravenous injection. After administration of NIF, VT/VF/AF was terminated in seven of the 10 patients, but a preventive effect was not obtained in any of the patients (NIF-resistance). Intravenous AMD (maintenance dose: 484 ± 166 mg/day) was effective both in termination (80%) and in prevention (80%) of VT/VF events in those patients. It was also effective in termination (80%) and prevention (60%) of AF events refractory to NIF. During continuous AMD administration, no significant adverse effects or proarrhythmic effects were observed in any of the patients. Five patients died within one month, but there was no arrhythmic deaths. Conclusions: Intravenous AMD was effective in NIF-resistant lethal arrhythmias and was relatively safe in emergent cases with severe heart failure.

AB - Background: Both nifekalant hydrochloride (NIF), a selective IKr blocker, and intravenous amiodarone (AMD), a multi-channel (including IKr blocking) blocker, have been reported to be efficacious for refractory arrhythmias. However, the optimal use of those antiarrhythmic drugs for refractory arrhythmia with severe heart failure has not been established. Intravenous AMD might be effective for arrhythmias refractory to NIF in patients with severe heart failure. Here, we report that intravenous amiodarone was effective in the treatment of nifekalant-resistant in a group of arrhythmia patients with severe heart failure. Methods: Eleven severe heart failure patients who had received intravenous AMD for treatment of NIF-resistant arrhythmias were included in this study, and retrospective analysis was performed. Clinical efficacy (terminative and preventive effects on arrhythmia) of intravenous AMD was evaluated. Results: All cases were emergent cases and had depressed left ventricular ejection fraction (30 ± 13%). Clinical arrhythmias were ventricular fibrillation (VF) in four patients, ventricular tachycardia (VT) in six patients, and atrial fibrillation (AF) in one patient. NIF was administered to all patients by intravenous injection. After administration of NIF, VT/VF/AF was terminated in seven of the 10 patients, but a preventive effect was not obtained in any of the patients (NIF-resistance). Intravenous AMD (maintenance dose: 484 ± 166 mg/day) was effective both in termination (80%) and in prevention (80%) of VT/VF events in those patients. It was also effective in termination (80%) and prevention (60%) of AF events refractory to NIF. During continuous AMD administration, no significant adverse effects or proarrhythmic effects were observed in any of the patients. Five patients died within one month, but there was no arrhythmic deaths. Conclusions: Intravenous AMD was effective in NIF-resistant lethal arrhythmias and was relatively safe in emergent cases with severe heart failure.

KW - Arrhythmias

KW - Atrial fibrillation

KW - Heart failure

KW - Ventricular arrhythmia

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