pyrimidinones and Postoperative-Complications

Arrhythmias are commonly occur after cardiac surgery. Recurrent sustained ventricular tachycardia and ventricular fibrillation in the acute phase after cardiac surgery is the most lethal arrhythmia and may warrant acute intervention and aggressive treatment. Although class I agents are usually ineffective and exacerbate the heart failure in cases with a low ejection fraction, nifekalant(a newer class III agent) and amiodarone can be effective. Hemodynamically tolerable sustained monomorphic ventricular tachycardia can be successfully terminated with ramp or burst pacing via an epicardial ventricular pacing lead. Initiation of intra-aortic balloon pumping and emergency percutaneous cardiopulmonary bypass and emergency catheter ablation can be considered for those patients not responding to the conventional resuscitative measures.

Topics: Amiodarone; Anti-Arrhythmia Agents; Cardiac Pacing, Artificial; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Catheter Ablation; Humans; Intra-Aortic Balloon Pumping; Postoperative Complications; Pyrimidinones; Recurrence; Tachycardia, Ventricular; Ventricular Fibrillation

Many cases have been successfully treated by us with experimented nifekalant hydrocholoride to prevent ventricular tachycardia (VT) during cardiac surgery. The 13 patients who underwent cardiac surgery at our hospital from 1999 to 2002 were retroactively given nifekalant hydrocholoride against VT. Lidocaine hydrochloride was not effective for VT, and it was difficult for 3 patients to be weaned for cardio-pulmonary bypass, while 6 patients needed aortic balloon pumping or percutaneous cardio-pulmonary support. Nifekalant hydrochloride suppressed VT induction in 9 patients (69.2%). Blood pressure and heart rate did not change, but QTc intervals were significantly increased with nifekalant hydrochloride (p < 0.005). Proarrhythmic events (Torsades de pointes) occurred in 2 patients, but none of the cases showed drug-induced worsening of cardiac function. Nifekalant hydrochloride is a class III antiarrhythmic drug that has been found to be effective against VT and ventricular fibrillation. While class I antiarrhythmic drugs are usually ineffective and induce severe heart failure, nifekalant hydrochloride can be effective.

Topics: Adult; Aged; Aged, 80 and over; Cardiovascular Surgical Procedures; Female; Humans; Infusions, Intravenous; Intraoperative Complications; Male; Middle Aged; Postoperative Complications; Pyrimidinones; Tachycardia, Ventricular; Treatment Outcome

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.

Topics: Aged; Anti-Arrhythmia Agents; Coronary Angiography; Coronary Artery Bypass; Coronary Stenosis; Follow-Up Studies; Humans; Infusions, Intravenous; Male; Myocardial Infarction; Postoperative Complications; Pyrimidinones; Severity of Illness Index; Tachycardia, Ventricular; Treatment Outcome

A 78-year-old man with chronic renal failure (CRF) on hemodialysis (HD) was diagnosed as having severe aortic regurgitation with left ventricular dysfunction. Aortic valve replacement with a 21 mm ATS mechanical bileaflet prosthesis was performed without intraoperative complications. Sustained ventricular tachycardia suddenly occurred 1 day after surgery, then intravenous administration of nifekalant hydrochloride (NIF) was started at a dose of 0.40 mg/kg/hr. Life-threating ventricular arrhythmia was controlled, hemodynamic compromise was improved dramatically. NIF was regulated with a low-dose of 0.24 mg/kg/hr to prevent malignant side effect such as torsa de pointes. Since QTc was elongated to 0.57 seconds 11 hours after administration, NIF was stopped. Low-dose intravenous administration of NIF in patients with CRF on HD could be useful to prevent ventricular tachyarrhythmias without any adverse effect after cardiac surgery.

Topics: Aged; Anti-Arrhythmia Agents; Aortic Valve; Heart Valve Prosthesis; Hemodialysis Solutions; Humans; Kidney Failure, Chronic; Male; Postoperative Complications; Pyrimidinones; Tachycardia, Ventricular

Two episode of junctional ectopic tachycardia (JET) caused hemodynamic deterioration early after tetralogy of Fallot repair in an 8-month-old infant. Sinus rhythm resumed in each of the episodes immediately after intravenous administration of nifekalant hydrochloride (NIF), a newly developed Vaughan-Williams class III antiarrhythmic drug in Japan. Although QT interval was modestly prolonged with NIF, no life-threatening ventricular arrhythmia (i.e., torsades de pointes) occurred. NIF might be an effective alternative in the treatment of postoperative JET in congenital cardiac surgery.

Topics: Anti-Arrhythmia Agents; Humans; Infant; Male; Postoperative Complications; Pyrimidinones; Tachycardia, Ectopic Junctional; Tetralogy of Fallot

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.

Topics: Adult; Aged; Aged, 80 and over; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Atrial Flutter; Cardiac Surgical Procedures; Female; Humans; Male; Middle Aged; Postoperative Complications; Pyrimidinones; Tachycardia, Ventricular; Ventricular Fibrillation

We experienced 2 effective cases of nifekalant hydrochloride. One patient was 76-year-old female who underwent emergent coronary artery bypass grafting (CABG) because of unstable angina pectoris (AP) and ventricular fibrillation (Vf). Her cardiac function had been decreased preoperatively due to old myocardial infarction (OMI). One day after CABG, she revealed sustained ventricular tachycardia (VT) and Vf. Although administrations of neither lidocaine hydrochloride nor magnesium sulfate were effective, nifekalant hydrochloride finally stopped the life-threatening arrhythmia without hypotension. Another patient was 77-year-old male who underwent CABG and Dor operation. His cardiac function also had been decreased due to OMI. He revealed VT attack at midnight 3 days after operation. VT attack still appeared at next 2 midnight under lidocaine hydrochloride infusion, but finally it has disappeared after starting a drip infusion of nifekalant hydrochloride. Nifekalant hydrochloride is quite useful as a new therapeutic strategy for uncontrollable VT and Vf and for the patient who has a reduced left ventricular function because it has an inotropic effect.

Topics: Aged; Anti-Arrhythmia Agents; Coronary Artery Bypass; Female; Humans; Injections, Intravenous; Male; Myocardial Ischemia; Postoperative Complications; Pyrimidinones; Tachycardia, Ventricular