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Ma Y, Guo L, Pang H, Yan Q, Li J, Hu M, Yi F. Failure of intravenous nifekalant cardioversion as an independent predictor for persistent atrial fibrillation recurrence after catheter ablation. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01713-7. [PMID: 38051431 DOI: 10.1007/s10840-023-01713-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/24/2023] [Indexed: 12/07/2023]
Abstract
AIMS Nifekalant is a class III antiarrhythmic drug that exerts antiarrhythmic effects by inhibiting rapid rectifying potassium channels and extending the effective refractory period of cardiomyocytes. It has a high success rate in converting atrial fibrillation (AF) to sinus rhythm. Whether the failure of intravenous nifekalant cardioversion is an independent predictor for persistent AF recurrence after catheter ablation has not been reported. METHODS A total of 92 patients with drug-refractory persistent AF were retrospectively enrolled. After all ablations, intravenous nifekalant was administrated. Patients were assigned to the success group (group 1) and failure group (group 2) based on nifekalant cardioversion results and followed for 12 months to note any episode of atrial arrhythmia recurrence. RESULTS Each group included 46 patients. After 12 months of follow-up, nine (19.6%) patients from group 1 and 23 (50.0%) patients from group 2 had a recurrence of atrial tachyarrhythmia (P = 0.002). AF duration and type 2 diabetes were strongly associated with failure of intravenous nifekalant cardioversion. Univariable Cox proportional hazard regression showed that failure of intravenous nifekalant cardioversion, AF duration, and type 2 diabetes were potential risk factors. Multivariable Cox proportional hazard regression showed that failure of nifekalant cardioversion was statistically associated with AF recurrence (adjusted RR = 2.257, 95% CI: 1.006-5.066, P = 0.048). Failure of intravenous nifekalant cardioversion could bring a positive effect on the prognostic differentiation when added into the multivariable model (0.767 ± 0.042 vs. 0.774 ± 0.045, P = 0.025). CONCLUSION Failure of nifekalant cardioversion is an independent predictor for persistent AF recurrence after catheter ablation.
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Affiliation(s)
- Yibo Ma
- Department of Cardiology, Xijing Hospital, Air Force Medical University, 169 Changle West Road, Xi'an, Shaanxi, 710032, China
| | - Lanyan Guo
- Department of Cardiology, Xijing Hospital, Air Force Medical University, 169 Changle West Road, Xi'an, Shaanxi, 710032, China
| | - Huani Pang
- Department of Cardiology, Xijing Hospital, Air Force Medical University, 169 Changle West Road, Xi'an, Shaanxi, 710032, China
| | - Qun Yan
- Department of Cardiology, Xijing Hospital, Air Force Medical University, 169 Changle West Road, Xi'an, Shaanxi, 710032, China
| | - Jie Li
- Department of Cardiology, Xijing Hospital, Air Force Medical University, 169 Changle West Road, Xi'an, Shaanxi, 710032, China
| | - Miaoyang Hu
- Department of Cardiology, Xijing Hospital, Air Force Medical University, 169 Changle West Road, Xi'an, Shaanxi, 710032, China
| | - Fu Yi
- Department of Cardiology, Xijing Hospital, Air Force Medical University, 169 Changle West Road, Xi'an, Shaanxi, 710032, China.
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Liu P, Li K, Wang S, Liu M, Wang L, Su G. Meta‑analysis of the efficacy and safety of nifekalant in the conversion of atrial fibrillation. Exp Ther Med 2023; 25:56. [PMID: 36588807 PMCID: PMC9780521 DOI: 10.3892/etm.2022.11755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/04/2022] [Indexed: 12/12/2022] Open
Abstract
Atrial fibrillation (AF) is the most common type of supraventricular tachyarrhythmia. Nifekalant is a new class III antiarrhythmic drug approved for the treatment of ventricular tachyarrhythmias, but its effectiveness in converting AF to sinus rhythm remains unclear. The present analysis aimed to investigate the effect of nifekalant in the conversion of AF. PubMed, Cochrane Library and China National Knowledge Infrastructure databases were systematically used to search relevant studies published between 1999 (data at which the drug was first approved for marketing in Japan) and 2022. Randomized clinical trials, prospective studies and retrospective studies on the use of nifekalant for AF were screened. The study metrics included the success rate of the conversion of AF, the mean time to conversion, the success rate of 12 months after a single AF catheter ablation procedure and the incidence of adverse events. The eligible studies screened included six randomized clinical trials, three prospective studies and three retrospective studies, totalling 12 studies with 1,162 patients. The risk ratio (RR) for successful conversion in the nifekalant and control groups was 1.95 [95% confidence interval (CI), 1.23-3.08; P=0.005] and the mean difference for the mean time to conversion was -1.73 [95% CI, -2.69-(-0.77); P=0.0004]. Statistically significant differences were observed between nifekalant and control groups. Subgroup analysis revealed a statistically significant difference in the success rate of conversion following catheter ablation in the nifekalant group compared with the amiodarone group and the RR value was 1.95 (95% CI, 1.37-2.77; P=0.0002). Statistically significant difference was observed compared with the electrical cardioversion group and the RR value was 0.90 (95% CI, 0.84-0.98; P=0.01). However, the combined RR values for the two groups were 1.18 (95% CI, 0.85-1.65; P<0.0002). The RR value for adverse events was 0.85 (95% CI, 0.51-1.43; P=0.55), with no statistically significant differences between nifekalant and control groups. In conclusion, the results demonstrated that the success rate and time to conversion in the nifekalant group were improved compared with those in the control group, particularly after catheter ablation, and the conversion effect with nifekalant was significantly improved compared with that in the control group.
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Affiliation(s)
- Peng Liu
- Cardiovascular Department, Center Hospital of Shandong First Medical University, Jinan, Shandong 250013, P.R. China
| | - Kaiyuan Li
- Cardiovascular Department, Center Hospital of Shandong First Medical University, Jinan, Shandong 250013, P.R. China
| | - Shuya Wang
- Cardiovascular Department, Center Hospital of Shandong First Medical University, Jinan, Shandong 250013, P.R. China
| | - Miao Liu
- Cardiovascular Department, Center Hospital of Shandong First Medical University, Jinan, Shandong 250013, P.R. China
| | - Lei Wang
- Cardiovascular Department, Center Hospital of Shandong First Medical University, Jinan, Shandong 250013, P.R. China
| | - Guohai Su
- Cardiovascular Department, Center Hospital of Shandong First Medical University, Jinan, Shandong 250013, P.R. China
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3
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Xiao H, Chen Q, Tao L. Long-term nifekalant use in a patient with dilated cardiomyopathy and recurrent ventricular tachycardia. J Int Med Res 2022; 50:3000605221133704. [PMID: 36300319 PMCID: PMC9620144 DOI: 10.1177/03000605221133704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The potential utility of nifekalant, a new Class III antiarrhythmic drug, to
offer long-term protection against ventricular arrhythmia has been investigated
in this case report. A 44-year-old male patient with dilated cardiomyopathy
complicated with heart failure and persistent ventricular tachycardia was
treated with nifekalant. The patient was treated with nifekalant for 31 days,
which effectively terminated ventricular tachycardia and maintained sinus
rhythm, with no clinical adverse reactions. After heart transplantation,
postoperative follow-up showed good cardiac function and no arrhythmia. On the
basis of nifekalant’s working mechanism, there is a good chance that it can cure
ventricular arrhythmia on a long-term basis.
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Affiliation(s)
- Hongyan Xiao
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital
Affiliated with the Wuhan University of Science and Technology, Wuhan, Hubei,
P.R. China,Wuhan Clinical Research Center for Cardiomyopathy, Wuhan, Hubei,
P.R. China
| | - Qitong Chen
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital
Affiliated with the Wuhan University of Science and Technology, Wuhan, Hubei,
P.R. China,Wuhan Clinical Research Center for Cardiomyopathy, Wuhan, Hubei,
P.R. China
| | - Liang Tao
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital
Affiliated with the Wuhan University of Science and Technology, Wuhan, Hubei,
P.R. China,Wuhan Clinical Research Center for Cardiomyopathy, Wuhan, Hubei,
P.R. China,Liang Tao, Department of Cardiac Surgery,
Wuhan Asia Heart Hospital Affiliated with the Wuhan University of Science and
Technology, No.753 Jinghan Ave, Wuhan, Hubei 430022, P.R. China. E-mail:
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4
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Ono K, Iwasaki YK, Akao M, Ikeda T, Ishii K, Inden Y, Kusano K, Kobayashi Y, Koretsune Y, Sasano T, Sumitomo N, Takahashi N, Niwano S, Hagiwara N, Hisatome I, Furukawa T, Honjo H, Maruyama T, Murakawa Y, Yasaka M, Watanabe E, Aiba T, Amino M, Itoh H, Ogawa H, Okumura Y, Aoki-Kamiya C, Kishihara J, Kodani E, Komatsu T, Sakamoto Y, Satomi K, Shiga T, Shinohara T, Suzuki A, Suzuki S, Sekiguchi Y, Nagase S, Hayami N, Harada M, Fujino T, Makiyama T, Maruyama M, Miake J, Muraji S, Murata H, Morita N, Yokoshiki H, Yoshioka K, Yodogawa K, Inoue H, Okumura K, Kimura T, Tsutsui H, Shimizu W. JCS/JHRS 2020 Guideline on Pharmacotherapy of Cardiac Arrhythmias. Circ J 2022; 86:1790-1924. [DOI: 10.1253/circj.cj-20-1212] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | - Yu-ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Masaharu Akao
- Department of Cardiovascular Medicine, National Hospital Organization Kyoto Medical Center
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine
| | - Kuniaki Ishii
- Department of Pharmacology, Yamagata University Faculty of Medicine
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshinori Kobayashi
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital
| | | | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | | | - Tetsushi Furukawa
- Department of Bio-information Pharmacology, Medical Research Institute, Tokyo Medical and Dental University
| | - Haruo Honjo
- Research Institute of Environmental Medicine, Nagoya University
| | - Toru Maruyama
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital
| | - Yuji Murakawa
- The 4th Department of Internal Medicine, Teikyo University School of Medicine, Mizonokuchi Hospital
| | - Masahiro Yasaka
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center
| | - Eiichi Watanabe
- Department of Cardiology, Fujita Health University School of Medicine
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Mari Amino
- Department of Cardiovascular Medicine, Tokai University School of Medicine
| | - Hideki Itoh
- Division of Patient Safety, Hiroshima University Hospital
| | - Hisashi Ogawa
- Department of Cardiology, National Hospital Organisation Kyoto Medical Center
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Chizuko Aoki-Kamiya
- Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular Center
| | - Jun Kishihara
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Eitaro Kodani
- Department of Cardiovascular Medicine, Nippon Medical School Tama Nagayama Hospital
| | - Takashi Komatsu
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University School of Medicine
| | | | | | - Tsuyoshi Shiga
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine
| | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University
| | - Shinya Suzuki
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Yukio Sekiguchi
- Department of Cardiology, National Hospital Organization Kasumigaura Medical Center
| | - Satoshi Nagase
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Noriyuki Hayami
- Department of Fourth Internal Medicine, Teikyo University Mizonokuchi Hospital
| | | | - Tadashi Fujino
- Department of Cardiovascular Medicine, Toho University, Faculty of Medicine
| | - Takeru Makiyama
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Mitsunori Maruyama
- Department of Cardiovascular Medicine, Nippon Medical School Musashi Kosugi Hospital
| | - Junichiro Miake
- Department of Pharmacology, Tottori University Faculty of Medicine
| | - Shota Muraji
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | | | - Norishige Morita
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital
| | - Hisashi Yokoshiki
- Department of Cardiovascular Medicine, Sapporo City General Hospital
| | - Koichiro Yoshioka
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine
| | - Kenji Yodogawa
- Department of Cardiovascular Medicine, Nippon Medical School
| | | | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
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5
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Di C, Gao P, Wang Q, Wu Y, Lin W. Intraprocedural Conversion Efficacy of Intravenous Nifekalant Administration for Persistent Atrial Fibrillation after Pulmonary Vein Isolation. Int Heart J 2020; 61:1157-1164. [PMID: 33191351 DOI: 10.1536/ihj.20-328] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study was to prospectively assess the efficacy, safety, and predictive effect of intravenous nifekalant administration for persistent atrial fibrillation (PerAF) after pulmonary vein isolation (PVI) with second-generation cryoballoon ablation (CBA) on 1-year atrial tachyarrhythmia (ATa) -free survival by examining the pharmacological conversion rate.One hundred and two drug-refractory, consecutive PerAF patients undergoing PVI were enrolled in this prospective observational study. After PVI, nifekalant (50 mg) was given followed by 30 minutes of observation and no further intervention. PerAF was successfully converted to sinus rhythm (SR) in 60 patients (58.8%) after a median time of 7.75 (4.13-12) minutes (group N). In the remaining 42 patients (41.2%) (group C), PerAF was successfully converted to SR by external electrical cardioversion. Nonsustained ventricular tachycardia occurred in 1 patient in group N. The left atrial volume (LAV) in group C was larger than that in group N (128.2 ± 28.2 versus 111.8 ± 24.5 mL, P = 0.002). Phrenic nerve injury occurred in 4 of 102 patients (3.9%). No other complications occurred during the procedure or within the 1-year follow-up period. At the 1-year follow-up, after a 3-month blanking period (BP), ATa-free survival during 1-year follow-up in group C was significantly lower than that in group N (50.0% versus 71.7%, P = 0.026), and the overall ATa-free survival rate was 62.7%. Two patients in group C and 4 patients in group N underwent a second procedure with radiofrequency catheter ablation. Multivariate Cox regression analysis demonstrated that unsuccessful conversion to SR (P = 0.025), ATa relapse during the BP (P = 0.000), and larger LAV (P = 0.016) were independent predictors of ATa recurrence at the 1-year follow-up.In conclusion, at the 1-year follow-up, the ATa-free survival rate after PVI with CBA for PerAF patients was 62.7%, and successful conversion to SR with nifekalant could serve as a clinical predictor of reduced ATa recurrence.
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Affiliation(s)
- Chengye Di
- Cardiac Electrophysiology Unit, First Department of Cardiology, TEDA International Cardiovascular Hospital
| | - Peng Gao
- Cardiac Electrophysiology Unit, First Department of Cardiology, TEDA International Cardiovascular Hospital
| | - Qun Wang
- Cardiac Electrophysiology Unit, First Department of Cardiology, TEDA International Cardiovascular Hospital
| | - Yanxi Wu
- Cardiac Electrophysiology Unit, First Department of Cardiology, TEDA International Cardiovascular Hospital
| | - Wenhua Lin
- Cardiac Electrophysiology Unit, First Department of Cardiology, TEDA International Cardiovascular Hospital
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Zhai Z, Xia Z, Xia Z, Hu J, Hu J, Zhu B, Xiong Q, Wu Y, Hong K, Chen Q, Yu J, Li J. Comparison of the efficacy and safety of different doses of nifekalant in the instant cardioversion of persistent atrial fibrillation during radiofrequency ablation. Basic Clin Pharmacol Toxicol 2020; 128:430-439. [PMID: 33037726 DOI: 10.1111/bcpt.13513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/26/2020] [Accepted: 10/02/2020] [Indexed: 11/28/2022]
Abstract
Nifekalant has been used in the treatment of atrial arrhythmia recently. However, there is no consensus on the preferable nifekalant dose to treat atrial fibrillation (AF). The purpose of this study was to explore efficacy and safety of different doses of nifekalant in the cardioversion of persistent AF. The study was a single-centre, randomized controlled trial. All subjects received nifekalant or placebo intravenously, and the nifekalant was given at the dosage of 0.3, 0.4 or 0.5 mg/kg. Primary efficacy end-point: compared with 0.3 mg group, the rate of cardioversion to sinus rhythm from AF in 0.4 and 0.5 mg group was higher. The 0.4 and 0.5 mg/kg doses were associated with a similar magnitude of efficacy (P > .05). Secondary efficacy end-point: termination rates of AF in the group of 0.4 mg and 0.5 mg were higher than 0.3 mg. Primary safety end-point: the rate of Torsades de Pointes or ventricular fibrillation was numerically lower in the 0.4 mg group than 0.5 mg group (P = .02). Secondary safety end-point: The rates of the majority of other common drug-related adverse events in the group of 0.5 and 0.4 mg were higher than the 0.3 mg group. A 0.4 mg/kg dose of intravenous nifekalant may be recommended during the radiofrequency ablation for persistent AF considering the benefit-risk profile.
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Affiliation(s)
- Zhenyu Zhai
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zirong Xia
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhen Xia
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jinzhu Hu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jianxin Hu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Bo Zhu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qinmei Xiong
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yanqing Wu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Kui Hong
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qi Chen
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - JianHua Yu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Juxiang Li
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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Yakabe D, Araki M, Furukawa K, Nakamura T. Atrial pacing and administration of nifekalant hydrochloride for unstable atrial fibrillation: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-5. [PMID: 32617511 PMCID: PMC7319856 DOI: 10.1093/ehjcr/ytaa093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/21/2019] [Accepted: 04/01/2020] [Indexed: 11/23/2022]
Abstract
Background Atrial fibrillation (AF) is a common arrhythmia in patients with hypertrophic cardiomyopathy (HCM) and can deteriorate haemodynamic status. Case summary We report a case of a 77-year-old woman with cardiogenic shock due to paroxysmal AF, complicated with HCM and aortic stenosis. Atrial fibrillation was successfully managed with temporary atrial pacing and administration of nifekalant hydrochloride without invasive mechanical circulatory support until surgery. Septal myectomy, aortic valve replacement, and pulmonary vein isolation were performed. Discussion This case suggests that atrial pacing and nifekalant may be safe and effective for rhythm control.
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Affiliation(s)
- Daisuke Yakabe
- Department of Cardiology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1, Jigyohama, Chuo-ku, Fukuoka, Fukuoka 810-8563, Japan
| | - Masahiro Araki
- Department of Cardiology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1, Jigyohama, Chuo-ku, Fukuoka, Fukuoka 810-8563, Japan
| | - Kojiro Furukawa
- Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1, Jigyohama, Chuo-ku, Fukuoka, Fukuoka 810-8563, Japan
| | - Toshihiro Nakamura
- Department of Cardiology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1, Jigyohama, Chuo-ku, Fukuoka, Fukuoka 810-8563, Japan
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8
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Yang L, Yu L, Chen Z, Zhang M. Nifekalant. JACC Case Rep 2020; 2:235-239. [PMID: 34317211 PMCID: PMC8298543 DOI: 10.1016/j.jaccas.2019.10.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/30/2019] [Accepted: 11/01/2019] [Indexed: 11/18/2022]
Abstract
Atrial fibrillation along with accessory pathway–induced ventricular pre-excitation may be life-threatening due to the high risk of developing severe hypotension, ventricular fibrillation, and sudden death. We demonstrate nifekalant as an effective agent in the pharmacological cardioversion of atrial fibrillation with high-risk accessory pathways. (Level of Difficulty: Intermediate.)
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Affiliation(s)
| | | | | | - Min Zhang
- Address for correspondence: Dr. Min Zhang, Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei 430022, China.
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Hu J, Yu J, Chen Q, Hu J, Huang Q, Xia Z, Xia Z, Ju Z, Yuan P, Fan S, Xiong Q, Zhu B, Huang L, You C, Bao H, Wu Y, Cheng X, Li J, Marian AJ, Hong K. Efficacy of Nifekalant in Patients With Wolff-Parkinson-White Syndrome and Atrial Fibrillation: Electrophysiological and Clinical Findings. J Am Heart Assoc 2019; 8:e012511. [PMID: 31234695 PMCID: PMC6662361 DOI: 10.1161/jaha.119.012511] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background The efficacy of nifekalant in preexcited atrial fibrillation (AF) has not been assessed. Methods and Results The study populations consisted of patients with sustained preexcited AF (n=51), paroxysmal supraventricular tachycardia (n=201), and persistent AF (n=87). Effects of intravenous infusion of nifekalant were assessed on electrophysiological and clinical parameters. Nifekalant prolonged the shortest preexcited R‐R, the average preexcited R‐R, and the average R‐R intervals from 290±35 to 333±44 ms, 353±49 to 443±64 ms, and 356±53 to 467±75 ms, respectively, in patients with preexcited AF (all P<0.001). Nifekalant also decreased the percentage of preexcited QRS complexes, heart rate, and increased systolic pressure (all P<0.001). Nifekalant terminated AF in 33 of 51 patients (65%). Similar effects were also observed in a subgroup of 12 patients with preexcited AF and impaired left ventricular function. In patients with paroxysmal supraventricular tachycardia, nifekalant significantly prolonged the effective refractory period, the block cycle length of the antegrade accessory pathway, and the atrial effective refractory period (all P<0.001). Nifekalant had no effect on the effective refractory period of the antegrade atrioventricular node. Finally, in patients with persistent AF without an accessory pathway, nifekalant did not significantly decrease the ventricular rate of AF. One patient developed Torsades de Pointes. No other adverse effects were observed. Conclusions Nifekalant prolongs the effective refractory period of the antegrade accessory pathway and atrium without blocking antegrade conduction through the atrioventricular node, leading to slowing and/or to termination of preexcited AF. Thus, nifekalant might be an effective and a relatively safe drug in patients with preexcited AF.
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Affiliation(s)
- Jinzhu Hu
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Jianhua Yu
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Qi Chen
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Jianxin Hu
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Qianghui Huang
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Zhen Xia
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Zirong Xia
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Zhenzhen Ju
- 3 Post-Anesthetic Care Unit The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Ping Yuan
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Siyang Fan
- 4 Clinical EP Laboratory and Arrhythmia Service Center of Fuwai Heart Hospital Beijing China
| | - Qinmei Xiong
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Bo Zhu
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Lin Huang
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Chunjiao You
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Huihui Bao
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Yanqing Wu
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Xiaoshu Cheng
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Juxiang Li
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
| | - Ali J Marian
- 5 Center for Cardiovascular Genetics Brown Foundation Institute of Molecular Medicine The University of Texas Health Science Center Houston TX
| | - Kui Hong
- 1 Department of Cardiovascular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China.,2 Jiangxi Key Laboratory of Molecular Medicine The Second Affiliated Hospital of Nanchang University Nanchang of Jiangxi China
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10
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Oka E, Iwasaki YK, Maru E, Fujimoto Y, Ito-Hagiwara K, Hayashi H, Yamamoto T, Yodogawa K, Hayashi M, Shimizu W. Differential Effectiveness of Landiolol Between Atrial Fibrillation and Atrial Flutter/Atrial Tachycardia Patients With Left Ventricular Dysfunction. Circ J 2019; 83:793-800. [PMID: 30814430 DOI: 10.1253/circj.cj-18-1131] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Landiolol, an ultra-short acting β1-selective blocker, is more effective for controlling the heart rate (HR) than digoxin in patients with atrial tachyarrhythmias and left ventricular (LV) dysfunction. The impact of the type of atrial tachyarrhythmias on the effectiveness of landiolol is uncertain. We evaluated the efficacy and safety of landiolol on tachycardiac atrial fibrillation (AF) and tachycardiac atrial flutter/atrial tachycardia (AFl/AT) in patients with reduced LV function. Methods and Results: Seventy-seven patients treated with landiolol were retrospectively analyzed. There were no significant differences in the baseline characteristics between the AF group (n=65) and AFl/AT group (n=12). Despite a higher dosage, the %change in HR from baseline to 12 and 24 h was only -10.2±12.7% and -16.1±19.4% in the AFl/AT group, while it was -28.3±13.2% and -31.3±11.3% in the AF group (P<0.02), respectively. The prevalence of the responders to landiolol treatment was much greater in the AF group than in the AFl/AT group (P<0.001). Alternative treatments such as i.v. amiodarone and electrical cardioversion were required in 83% of the AFl/AT patients. CONCLUSIONS Landiolol was ineffective in the majority of AFl/AT patients. An alternative management to prevent any worsening of heart failure might be considered in those patients.
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Affiliation(s)
- Eiichiro Oka
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Yu-Ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Eugene Maru
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Yuhi Fujimoto
- Department of Cardiovascular Medicine, Nippon Medical School
| | | | - Hiroshi Hayashi
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Teppei Yamamoto
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Kenji Yodogawa
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Meiso Hayashi
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
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11
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Kawaji T, Shizuta S, Yamagami S, Aizawa T, Komasa A, Yoshizawa T, Kato M, Yokomatsu T, Miki S, Ono K, Kimura T. Clinical Utility of Intravenous Nifekalant Injection during Radiofrequency catheter Ablation for Persistent Atrial Fibrillation. J Atr Fibrillation 2018; 11:1839. [PMID: 30455835 DOI: 10.4022/jafib.1839] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 02/19/2018] [Accepted: 05/14/2018] [Indexed: 11/10/2022]
Abstract
Background Radiofrequency catheter ablation (RFCA) for persistent atrial fibrillation (AF) is still challenging even in RFCA-era for AF. The aim of this study was to assess the clinical utility of nifekalant, a pure potassium channel blocker,during RFCA for persistent AF. Methods and results We retrospectively enrolled 157 consecutive persistentAF patientsundergoing first RFCA procedure withcomplex fractionated atrial electrogram (CFAE)ablation after pulmonary veins isolation and compared outcomes between patientswith (NFK group: N=79) and without (No-NFK group: N=78)additional CFAE ablation using intravenous nifekalant (0.3mg/kg). Primary endpoint was 24-month atrial arrhythmia-free survival post ablation.The prevalence of AF terminationwas significantly higher in NFK group than No-NFK group (64.6% versus 7.7%, P<0.001). Arrhythmia-free survival, however, was not significantly different between 2 groups (61.5% versus 54.1%, P=0.63).There was no significant difference between 2 groups in the prevalence of recurrent atrial tachycardia(25.0% versus 23.5%, P=0.89). Arrhythmia-free survivalin patients with AF termination during procedure was significantly higher thanthose without (73.0% versus 41.0%, P=0.002; adjusted hazard ratio 0.48, 95% confidence interval 0.17-0.84, P=0.02) amongNFK group,but not amongNo-NFK group (66.7% versus 53.2%, P=0.53). Conclusions Intravenous nifekalant injection during additional CFAE ablation did not improve sinus maintenancerate after RFCA procedure for AF, but AF termination by nifekalant injection could be a clinical predictor of better success rates after procedure.
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Affiliation(s)
| | - Satoshi Shizuta
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Shintaro Yamagami
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Takanori Aizawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Akihiro Komasa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Takashi Yoshizawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masashi Kato
- Department of Cardiology, Mitsubishi Kyoto Hospital
| | | | - Shinji Miki
- Department of Cardiology, Mitsubishi Kyoto Hospital
| | - Koh Ono
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
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12
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MORITA NORISHIGE, KOBAYASHI YOSHINORI, IWASAKI YUKI, HAYASHI MEISO, MIYAUCHI YASUSHI, ATARASHI HIROTSUGU, TANAKA KEIJI, KATOH TAKAO, MIZUNO KYOICHI. Characterization of Transient Atrial Rhythm Occurring between Typical Atrial Flutter and Its Termination with Class III Drugs. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:943-54. [DOI: 10.1111/j.1540-8159.2008.01120.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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