Nishida M, Okada H, Murakami M, Hamano K
Division of Cardiovascular Surgery, Shakaihoken Tokuyama Central Hospital, Shunan, Japan.
Kyobu Geka. 2006 Mar;59(3):210-3.
Ventricular tachycardia (VT), ventricular fibrillation (VF), and atrial flutter (AFL) are potentially fatal or serious complications arising after cardiac surgery. Generally, we treat these complications with class I antiarrhythmic agents and/or direct counter shock (DC). However, sometimes these complications do not respond to antiarrhythmic agents and require frequent DC. Moreover, these class I agents induce heart failure due to their negative inotropic effect. Nifekalant hydrochloride (NIF) is a class III antiarrhythmic agent that prolongs the refractory period of the atrial and ventricular myocardium without any negative inotropic action. From July 2003 to September 2004, we treated 11 patients with NIF for perioperative arrhythmias (VT 5, VF 2, and AFL 4). NIF was administered by continuous intravenous infusion (0.3 to 0.4 mg/ kg/h) to prevent the recurrence of VT/VF and AFL. NIF prevented the recurrence of VT in 3 of the 5 cases. No recurrence was observed in 2 cases with VF. Furthermore, NIF prevented the recurrence of AFL in all the 4 patients. None of the patients exhibited changes in heart rate, cardiac output, and QTc interval. Additionally, no occurrence of Torsades de pointes was observed in any of the cases. In conclusion, NIF is an effective and safe antiarrhythmic agent for the treatment of perioperative arrhythmias under continuous monitoring of the QTc interval.
室性心动过速（VT）、心室颤动（VF）和心房扑动（AFL）是心脏手术后可能出现的致命或严重并发症。一般来说，我们使用I类抗心律失常药物和/或直接电击除颤（DC）来治疗这些并发症。然而，有时这些并发症对抗心律失常药物无反应，需要频繁进行DC治疗。此外，这些I类药物因其负性肌力作用会诱发心力衰竭。盐酸尼非卡兰（NIF）是一种III类抗心律失常药物，可延长心房和心室心肌的不应期，且无任何负性肌力作用。2003年7月至2004年9月，我们使用NIF治疗了11例围手术期心律失常患者（VT 5例、VF 2例和AFL 4例）。通过持续静脉输注（0.3至0.4mg/kg/h）给予NIF，以预防VT/VF和AFL的复发。NIF预防了5例VT患者中3例的复发。2例VF患者未观察到复发。此外，NIF预防了所有4例AFL患者的复发。所有患者的心率、心输出量和QTc间期均未出现变化。此外，所有病例均未观察到尖端扭转型室性心动过速的发生。总之，在持续监测QTc间期的情况下，NIF是一种治疗围手术期心律失常有效且安全的抗心律失常药物。
