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[The effect of MS-551 on two VT/Vf patients in CABG: a case report]
1Department of Cardiovascular Surgery and Cardiology, Heart Institute of Japan, Tokyo Women's Medical College, Japan.
Insights
Recurrent ventricular tachycardia/fibrillation (VT/Vf) during coronary artery bypass grafting (CABG) was successfully treated with MS-551 when other antiarrhythmics failed. These cases suggest MS-551 efficacy in acute myocardial infarction settings.
Area of Science:
- Cardiology
- Cardiac Surgery
- Pharmacology
Background:
- Uncontrollable arrhythmia poses a significant risk of operative death in patients undergoing Coronary Artery Bypass Grafting (CABG).
- Recurrent Ventricular Tachycardia/Fibrillation (VT/Vf) is a life-threatening complication that can occur post-cardiac surgery.
- Standard antiarrhythmic agents like lidocaine, verapamil, and amiodarone are not always effective in managing these critical arrhythmias.
Observation:
- Two patients undergoing CABG experienced sudden, recurrent VT/Vf after cardiopulmonary bypass (CPB).
- In both cases, conventional treatments (lidocaine, verapamil, amiodarone) failed to stabilize the cardiac rhythm.
- Intravenous administration of MS-551 rapidly terminated the VT/Vf in both patients.
Findings:
- MS-551 demonstrated prompt and effective control of recurrent VT/Vf in CABG patients unresponsive to standard therapies.
- These findings challenge the conventional limitation of MS-551 use primarily to patients with Dilated Cardiomyopathy (DCM).
- The successful use of MS-551 in these acute myocardial infarction scenarios provides crucial clinical data.
Implications:
- MS-551 may represent a viable therapeutic option for managing refractory VT/Vf during and after CABG operations.
- This study suggests a potential expanded role for MS-551 in treating acute myocardial infarction-induced arrhythmias.
- Further clinical trials are warranted to confirm the efficacy and safety of MS-551 in acute settings.
Abstract:
Uncontrollable arrhythmia is one of the causes of operative death in CABG. We report two cases of successful treatment of recurrent VT/Vf in CABG operation by MS-551. One case was a 72-year-old male, who had unstable angina and OMI with left ventricular dysfunction (LVEF 24%). After weaning from CPB, the rhythm turned into VT/Vf suddenly. Lidocaine and verapamil were not effective. VT/Vf recurred over the over. The another case was a 52-year-old male, who had OMI and effort angina. He became myocardial infarction during operation. VT/Vf occurred after the weaning from CPB. Lidocaine and amiodarone were of no effect on his VT/Vf. In both cases, intravenous injection of MS-551 promptly stopped VT/Vf. Use of MS-551 was limited mainly on DCM patients. But other antiarrhythmic agents were ineffective on these cases. We have had to continue support circulation for a long time without MS-551. As MS-551 is being used as a trial on medically followed patients, it was unknown how effective clinically on the acute myocardial infarction. In this regard, our cases may suggest a positive answer to that.