Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Dec 26, 2024; 16(12): 768-775
Published online Dec 26, 2024. doi: 10.4330/wjc.v16.i12.768
Nicorandil as a promising therapeutic option for ventricular arrhythmia: A case report and review of literature
Ling-Yu Bai, Ming Zhao, Kui-Ying Ma
Ling-Yu Bai, Ming Zhao, Kui-Ying Ma, Department of Cardiovascular Medicine, Affiliated Hospital of Inner Mongolia University for Nationalities, Tongliao 028000, Inner Mongolia Autonomous Region, China
Author contributions: Bai LY and Ma KY performed the study; Bai LY and Zhao M analyzed the data; Bai LY wrote the manuscript; and all authors have read and approved the final manuscript.
Supported by the Inner Mongolia Natural Science Foundation of China, No. 2017MS(LH)0824.
Informed consent statement: Study participants or her legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ming Zhao, PhD, Department of Cardiovascular Medicine, Affiliated Hospital of Inner Mongolia University for Nationalities, No. 1742 East Section of Holinhe Street, Tongliao 028000, Inner Mongolia Autonomous Region, China. langzhe73@163.com
Received: July 10, 2024
Revised: October 23, 2024
Accepted: November 19, 2024
Published online: December 26, 2024
Processing time: 138 Days and 17.8 Hours
Abstract
BACKGROUND

Ventricular arrhythmia is a common type of arrhythmia observed in clinical practice. It is primarily characterized by premature ventricular contractions, ventricular tachycardia, and ventricular fibrillation. Abnormal formation or transmission of cardiac electrical impulses in patients affects cardiac ejection function. It may present with symptoms such as palpitations, dyspnea, chest discomfort, and reduced exercise tolerance. In severe cases, ventricular arrhythmia can even lead to death. Therefore, prompt treatment is very much essential upon diagnosis. The symptoms did not improve after previous conventional drugs and electrical defibrillation treatment, but the ventricular arrhythmia was prevented after the addition of nicorandil.

CASE SUMMARY

A 75-year-old female patient was admitted to the hospital because of intermittent chest tightness, shortness of breath for 10 days, and fainting once for 7 days. Combined with laboratory tests and auxiliary examination, the patient was tentatively diagnosed with coronary heart disease or arrhythmia-atrial fibrillation. After admission, the patient had intermittent ventricular arrhythmia, which was uncontrolled with lidocaine, defibrillation, and amiodarone. However, when she was treated with nicorandil, the ventricular arrhythmia stopped. Nicorandil mitigates the action potential duration by facilitating the opening of potassium ion channels, thereby regulating the likelihood of premature and delayed depolarization in two distinct phases and subsequently averting the onset of malignant ventricular arrhythmia. Nicorandil may inhibit ventricular arrhythmia by dilating coronary arteries, improving coronary microcirculation and reducing myocardial fibrosis.

CONCLUSION

Nicorandil is a drug with dual effects. It could be used as a new therapeutic option for inhibiting ventricular arrhythmias.

Keywords: Nicorandil; Ventricular arrhythmia; Electrical storm; Phase 2 early after-depolarization; Amiodarone; Microcirculation; Myocardial fibrosis; Lidocaine; Case report

Core Tip: The frequent occurrence of ventricular arrhythmia can be life-threatening, so the treatment of ventricular arrhythmia is particularly important. Treatment of ventricular arrhythmia includes pharmacological and nonpharmacological options. Our patient after receiving medical treatments include lidocaine, amiodarone, and electric defibrillation. Ventricular arrhythmia was not controlled. After application of nicorandil, ventricular arrhythmia was controlled and the rate of patient recovered sinus heart rate. Nicorandil provides a new idea for treating ventricular arrhythmia.