Successful Hybrid Therapy Combined with Oral Bepridil and lCD in a Patient with Amiodarone Refractory Life-threatening Ventricular Tachyarrhythmia Associated with Ischemic Cardiomyopathy

Abstract

A 68-year-old man was admitted to our hospital for the treatment of angina and ventricular tachyarrhythmia. A coronary and left ventricular angiography showed coronary artery disease and ischemic cardiomyopathy with severe left ventricular dysfunction. A percutaneous transluminal coronary angioplasty was performed successfully in the right coronary artery and his angina symptoms disappeared. However, ventricular tachycardia (VT) /ventricular fibrillation (VF) occurred spontaneously and converted to sinus rhythm with direct current shock (300J). Oral amiodarone (200 mg/day) and continuous intravenous infusion of nifekalant and lidocaine were started. In addition, a dual chamber implantable cardioverter defibrillator (ICD) for his VT/VF was implanted. However, VT/VF occurred repeatedly after discontinuation of nifekalant. After the administration of bepridil (200 mg/day), VT/VF was completely prevented without nifekalant administration. The hybrid therapy with lCD and oral bepridil is very useful for the treatment of amiodarone resistant ventricular tachyarrhythmia.