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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.

In this study, a simple and selective high-performance liquid chromatography method was developed and validated for the determination of nifekalant hydrochloride in canine plasma. Liquid –liquid extraction was used to separate nifekalant hydrochloride from canine plasma and the mean extraction recoveries of nifekalant hydrochloride and the internal standard were 82.31 and 94.81%, respectively. The chromatographic separation was performed on a Dikma Diamonsil column with a mobile phase consisting of acetonitrile –20mM phosphate buffer ( pH 6.2; 30:70, v/v) with flow rate of 1.0 mL/min. The standard curve was linear over the concentration range of 20 –10,000 ng/mL (r 2 > 0.99). The intra-batch and inter-batch accuracy for nifekalant hydrochloride at four concentrations were 93.14–100.47% and 96.12–103.77%, respectively. The relative standard deviations were less than 15%. The method was successfully applied to a pharmacokinetic study after the intravenous administration of nifekalant hydrochloride to beagle dogs.

Background : Although nifekalant hydrochloride (NIFE) has been demonstrated to suppress ventricular tachyarrhythmia, especially electrical storm, the mechanism by which it does so is still unclear. We examined its effects on the spatial dispersion of repolarization (SDR) after implantable cardioverter-defibrillator (ICD) shock. / Methods and Results : In twenty five patients with an ICD, we recorded the 87-lead ECG during sinus rhythm (the CONTROL group) under general anesthesia, after NIFE administration alone, and just after termination of induced ventricular fibrillation (VF) by ICD shock with or without NIFE administration....

Nifekalant hydrochloride is a novel class III antiarrythmic agent used especially for malignant VT/VF, which is resistant to electrical defibrillation and lidocaine. We previously reported that this agent restored the sinus rhythm from ventricular fibrillation more successfully than lidocaine. A 60-year-old female was transferred to the Emergency Medical Center of Tokai University Hospital because of cardiac arrest due to ventricular fibrillation. After several unsuccessful attempts at electrical defibrillation at the scene and the emergency room, we administrated nifekalant hydrochloride before lidocaine. With the infusion of nifekalant, the patient was successfully defibrillated. A 57-year-old female also admitted to our hospital with recurrent ventricular fibrillation that was resistant to electrical defibrillation. In situations of VT/VF resistance to electrical defibrillation, lidocaine has been used prior to nifekalant. However, we selected nifekalant first, with which the patient was successfully defibrillated. After the infusion of nifekalant hydrochloride, the sinus rhythm was restored. We concluded that nifekalant hydrochloride is especially effective for recurrent ventricular fibrillation and it should be administrated as early as possible.

An "electrical storm" is a life-threatening condition defined as a recurrent attack of ventricular tachycardia or fibrillation. The current report is a case study of a patient who had electrical storms developing unexpectedly after undergoing coronary artery bypass grafting. The electrical storms were terminated dramatically by the administration of nifekalant hydrochloride. We suggest that nifekalant hydrochloride has great therapeutic potential for the suppression of intractable ventricular tachyarrhythmias refractory to amiodarone.

We report two cases that the combination of amiodarone and nifekalant hydrochloride (NIF) is useful against electrical storm (ES). The first patient is 81-year-old man with CRT-D because of ischemic cardiomyopathy (ICM). He was admitted to add class III antiarrhythmic agent due to frequent ICD therapy. On admission day he felt palpitation followed by strong shock. Electrocardiogram showed frequent sustained VT accompanying ICD therapy. The injection of amiodarone followed by continuous intravenous injection (CIV) reduced the frequency of VT, but not suppressed completely. After additional CIV of NIF the patient no longer experienced the VT. During the ES 60 times of antitachycardia pacing, 13 times of 15 J cardioversion, and nine times of 35 J direct current were recorded in no more than 19 minutes. The second one is 56-year-old man with chronic heart failure due to ICM. He was admitted to control heart failure (HF). In spite of the treatment for HF, he had sustained VT with circulatory collapse and CRT-D was implanted. After the implantation, even taking oral amiodarone, he had ES and underwent the treatment with ICD shocks. Also in this case, additional CIV of NIF suppressed the VT and reduced ICD shock dramatically.