Useful Combination of Amiodarone and Nifekalant Hydrochloride in Treatment against Electrical Storm: A Report of Two Cases

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We report two cases that the combination of amiodarone and nifekalant hydrochloride (NIF) is useful against electrical storm (ES). The first patient is 81-year-old man with CRT-D because of ischemic cardiomyopathy (ICM). He was admitted to add class III antiarrhythmic agent due to frequent ICD therapy. On admission day he felt palpitation followed by strong shock. Electrocardiogram showed frequent sustained VT accompanying ICD therapy. The injection of amiodarone followed by continuous intravenous injection (CIV) reduced the frequency of VT, but not suppressed completely. After additional CIV of NIF the patient no longer experienced the VT. During the ES 60 times of antitachycardia pacing, 13 times of 15 J cardioversion, and nine times of 35 J direct current were recorded in no more than 19 minutes. The second one is 56-year-old man with chronic heart failure due to ICM. He was admitted to control heart failure (HF). In spite of the treatment for HF, he had sustained VT with circulatory collapse and CRT-D was implanted. After the implantation, even taking oral amiodarone, he had ES and underwent the treatment with ICD shocks. Also in this case, additional CIV of NIF suppressed the VT and reduced ICD shock dramatically.