Use of Intravenous Amiodarone in the Treatment of Nifekalant-Resistant Arrhythmia: A Review of 11 Consecutive Cases with Severe Heart Failure

Pharmaceuticals

Koji Nakagawa³  Kazufumi Nakamura³  Kengo Fukushima Kusano³  Satoshi Nagase³  Takeshi Tada³  Masato Murakami³  Yoshiki Hata³  Hiroshi Morita³  Kunihisa Kohno³  Kazumasa Hina¹  Tohru Ujihira²  Tohru Ohe³ 

[1] Department of Cardiology, Okayama Heart Clinic, Okayama, 7008558, Japan;Department of Cardiology, Okayama Redcross Hospital, Okayama, 7008558, Japan;Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 7008558, Japan

关键词: arrhythmias;    heart failure;    ventricular arrhythmia;    atrial fibrillation;   

DOI  :  10.3390/ph4060794

来源: mdpi

【 摘 要 】

Background: Both nifekalant hydrochloride (NIF), a selective I_Kr blocker, and intravenous amiodarone (AMD), a multi-channel (including I_Kr 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.

【 授权许可】

CC BY   
© 2011 by the authors; licensee MDPI, Basel, Switzerland.