Preventive Effect of Nifekalant on Recurrent Ventricular Fibrillation and Electrical Storm　― A Systematic Review and Meta-Analysis ―

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Background: Several antiarrhythmic agents, including amiodarone (AMD) and nifekalant (NIF), are used in the management of life-threatening arrhythmias such as ventricular fibrillation (VF) and ventricular tachycardia (VT). Although a few studies have compared the antiarrhythmic effect of NIF and AMD, most have focused on termination or defibrillation of VF/VT. In this meta-analysis, we aimed to assess the current evidence on the preventive effects of NIF and AMD on recurrent VF and electrical storm (ES).

Methods and Results: The protocol was registered in PROSPERO (CRD42024578486). PubMed (MEDLINE and PMC), Cochrane Central Register of Controlled Trials (CENTRAL), Science Citation Index Expanded, and Igaku Chuo Zasshi were searched for observational studies and randomized controlled trials evaluating patients with cardiac arrest due to recurrent VF and ES treated with AMD or NIF, published before 28 August 2024. The primary endpoint was the recurrence of VF/VT. Secondary outcomes included short-term death and incidence of torsades de pointes (TdP). 5 eligible studies comprising 222 participants were included. Evidence regarding differences between NIF and AMD in the recurrence of VF/VT, short-term death, and incidence of TdP was of very low certainty and remains highly uncertain.

Conclusions: NIF and AMD may have little to no difference in preventing the recurrence of VF/VT, short-term death, or incidence of TdP; however, the certainty of the evidence is very low.