Nifekalant versus lidocaine for in-hospital shock-resistant ventricular fibrillation or tachycardia.

Abstract

OBJECTIVE:

To compare the efficacy and safety of nifekalant, a pure class III anti-arrhythmic drug, and lidocaine in patients with shock-resistant in-hospital ventricular fibrillation (VF) or ventricular tachycardia (VT).

PATIENTS AND METHODS:

Between August 2005 and March 2008, we conducted a prospective, two-arm, cluster observational study, in which participating hospitals were pre-registered either to the nifekalant arm or the lidocaine arm. Patients were enrolled if they had in-hospital VF or VT resistant to at least two defibrillation shocks. Congenital or drug-induced long QT syndrome was excluded. The primary end-point was termination of VF or VT with/without additional shock. The secondary end-points were return of spontaneous circulation (ROSC), 1-month survival and survival to hospital discharge. We also assessed the frequency of adverse events, including asystole, pulseless electrical activity and torsade de pointes.

RESULTS:

In total, 55 patients were enrolled. After nifekalant, 22 of 27 patients showed termination of VF or VT, as compared with 15 of 28 patients treated with lidocaine with/without additional shock (odds ratio (OR): 3.8; 95% confidence interval (CI): 1.1-13.0; P=0.03). Twenty-three of 27 patients given nifekalant showed ROSC, as compared with 15 of 28 patients given lidocaine (OR: 5.0; 95% CI: 1.4-18.2; P=0.01). There was no difference in 1-month survival or survival to hospital discharge between the nifekalant and lidocaine arms. There was a higher incidence of asystole with lidocaine (7 of 28 patients) than with nifekalant (0 of 27 patients) (P=0.005). Torsade de pointes was not observed.

CONCLUSION:

Nifekalant was more effective than lidocaine for termination of arrhythmia and for ROSC in patients with shock-resistant in-hospital VF or VT (umin-CTR No. UMIN 000001781).

• Authors: Tsuyoshi Shiga, Keiji Tanaka, Rinya Kato, Mari Amino, Yuji Matsudo, Toshihiro Honda, Koichi Sagara, Atsushi Takahashi, Takao Katoh, Mitsuyoshi Urashima, Satoshi Ogawa, Teruo Takano, Hiroshi Kasanuki, Refractory VT/VF, Prospective Evaluation to Differentiate Lidocaine Efficacy from Nifekalant (RELIEF) Study Investigators
• Journal: Resuscitation (Resuscitation) Vol. 81 Issue 1 Pg. 47-52 (Jan 2010) ISSN: 1873-1570 [Electronic] Ireland
• PMID: 19913983 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

Chemical References

• Anti-Arrhythmia Agents
• Pyrimidinones
• nifekalant
• Lidocaine

Topics

• Aged
• Anti-Arrhythmia Agents (therapeutic use)
• Chi-Square Distribution
• Female
• Humans
• Lidocaine (therapeutic use)
• Male
• Middle Aged
• Prospective Studies
• Pyrimidinones (therapeutic use)
• Statistics, Nonparametric
• Survival Rate
• Tachycardia, Ventricular (drug therapy, physiopathology, therapy)
• Treatment Outcome
• Ventricular Fibrillation (drug therapy, physiopathology, therapy)