尼非卡兰治疗严重左心室收缩功能不全患者心房性心动过速心源性休克

Q4 Medicine

JACC. Case reports Pub Date : 2025-10-01 DOI:10.1016/j.jaccas.2025.105329

Hiroyuki Mizukami MD , Takafumi Oka MD, PhD , Ryohei Sakai MD, PhD , Takayuki Sekihara MD , Yasuhiro Akazawa MD, PhD , Daisuke Nakamura MD , Fusako Sera MD, PhD , Isamu Mizote MD, PhD , Tomohito Ohtani MD, PhD , Yasushi Sakata MD, PhD

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引用次数: 0

摘要

背景：急性心力衰竭伴左心室射血分数（LVEF）降低时的室性心动过速（AT）可使血流动力学恶化。抗心律失常药物受到负性肌力作用的限制。一例55岁男性特发性扩张型心肌病患者在持续AT治疗下心力衰竭恶化。他的LVEF已降至12%。多次ATs引起对肌力药物和利尿剂的耐药性。反复电复律与静脉胺碘酮失败的原因是复发性心房收缩引发的ATs，导致心源性休克。静脉给予尼非卡兰和地高辛以控制节律和速率。电转复后，心房早搏不再诱发AT。连续的尼非卡兰维持了窦性心律，使休克在没有机械支持的情况下得以恢复。导管消融、心脏再同步化治疗和口服索他洛尔可实现长期心律控制。患者于第96天出院。nifekalant是一种选择性延迟整流钾电流阻滞剂，以最小的肌力作用延长难治性，稳定心律并为最终治疗架起桥梁。对于LVEF严重降低和血流动力学不稳定的难治性AT患者，agenifekalant可能有效。

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Nifekalant for Atrial Tachycardia–Induced Cardiogenic Shock in a Patient With Severe Left Ventricular Systolic Dysfunction

Background

Atrial tachycardia (AT) during acute heart failure with reduced left ventricular ejection fraction (LVEF) can worsen hemodynamics. Antiarrhythmic drugs are limited by negative inotropic effects.

Case Summary

A 55-year-old man with idiopathic dilated cardiomyopathy was admitted with worsening heart failure under sustained AT. His LVEF had declined to 12%. Multiple ATs caused resistance to inotropes and diuretics. Repeated electrical cardioversion with intravenous amiodarone failed owing to recurrent ATs triggered by premature atrial contractions, leading to cardiogenic shock. Intravenous nifekalant and digoxin were administered for rhythm and rate control. After electrical cardioversion, premature atrial contractions no longer induced AT. Continuous nifekalant maintained sinus rhythm, allowing recovery from shock without mechanical support. Catheter ablation, cardiac resynchronization therapy, and oral sotalol achieved long-term rhythm control. The patient was discharged on day 96.

Discussion

Nifekalant, a selective delayed rectifier potassium current blocker, prolongs refractoriness with minimal inotropic effect, stabilizing rhythm and bridging to definitive therapy.