Abstract
Purpose: There have been few reports of nifekalant (NIF) for the management of arrhythmias in children, and its efficacy and safety remains to be established. We studied children treated with NIF in our institution.
Methods: The subjects were 28 patients (6 days to 18 years old; 20 males and 8 females) who received NIF. NIF was used to manage postoperative arrhythmias in 25 patients with congenital heart disease and in 3 patients with cardiomyopathy. We retrospectively studied the antiarrhythmic effectiveness and characteristics of patients with torsades de pointes (Tdp).
Results: NIF effectively controlled arrhythmias in 25 patients (89%), but induced Tdp in 5 patients (18%). QT intervals corrected by Bazett's formula (QTc[B]) and Fridericia's formula (QTc[F]) were both significantly longer in patients with Tdp than in those without Tdp (median, 585 vs. 460 msec, p = 0.001 and median, 535 vs. 410 msec, p = 0.001, respectively). Receiver-operating-characteristic curve analysis showed that the cutoff point of QTc (B) values for Tdp was 531 msec and that of QTc (F) values for Tdp was 460 msec.
Conclusion: Our results suggest that NIF is effective for arrhythmias in children, but the development of Tdp should be carefully monitored, especially when QTc (B) values are 531 msec or longer or QTc (F) values are 460 msec or longer.
