{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T03:51:07Z","timestamp":1791258667903,"version":"4.1.0"},"reference-count":13,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pharmacologic cardioversion of atrial flutter (AFL) remains challenging, particularly in older or frail patients who are not candidates for catheter ablation. Nifekalant is effective for AFL but is limited by QT prolongation and the risk of torsades de pointes (TdP). Magnesium sulfate may mitigate this risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this multicenter, investigator\u2010initiated pilot study, 86 patients with symptomatic persistent AFL received intravenous magnesium sulfate followed by nifekalant. The primary outcome was AFL termination within 60 min. Time to termination and safety outcomes, including TdP, were assessed. Multivariable logistic regression analyses were performed to identify factors associated with AFL termination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>AFL terminated in 42 patients (48.8%). Among patients with successful cardioversion, 80% achieved termination within 20 min. Larger left atrial diameter was associated with a lower likelihood of AFL termination. Adverse events occurred in 2 patients (2.3%), including sinus pauses requiring pacemaker implantation and transient hypotension requiring vasopressor support. No cases of TdP were observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings suggest that the nifekalant\u2013magnesium cocktail may be a feasible and potentially safe option for chemical cardioversion of AFL, warranting further investigation in larger studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pace.70301","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T09:16:42Z","timestamp":1779355002000},"page":"1641-1646","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Nifekalant\u2013Magnesium Cocktail for Chemical Cardioversion of Atrial Flutter: A Multicenter Pilot Study"],"prefix":"10.1111","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0873-1508","authenticated-orcid":false,"given":"Akinori","family":"Sairaku","sequence":"first","affiliation":[{"name":"Department of Cardiology National Hospital Organization Higashihiroshima Medical Center  Higashihiroshima Japan"},{"name":"Department of Cardiovascular Medicine Hiroshima University Graduate School of Biomedical and Health Sciences  Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michitaka","family":"Amioka","sequence":"additional","affiliation":[{"name":"Department of Cardiology Onomichi General Hospital  Onomichi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshikazu","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Cardiology Hiroshima City Hiroshima Citizens Hospital  Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1328-2855","authenticated-orcid":false,"given":"Shunsuke","family":"Tomomori","sequence":"additional","affiliation":[{"name":"Department of Cardiology Hiroshima City Hiroshima Citizens Hospital  Hiroshima Japan"},{"name":"Department of Cardiology Hiroshima Prefectural Hospital  Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukihiro","family":"Fukuda","sequence":"additional","affiliation":[{"name":"Department of Cardiology National Hospital Organization Higashihiroshima Medical Center  Higashihiroshima Japan"},{"name":"Department of Cardiology Hiroshima Prefectural Hospital  Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukiko","family":"Nakano","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Hiroshima University Graduate School of Biomedical and Health Sciences  Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.16542"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1476-5381.1993.tb13546.x"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8159.2007.00846.x"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/pace.12147"},{"key":"e_1_2_10_6_1","first-page":"1790","article-title":"Japanese Circulation Society and Japanese Heart Rhythm Society Joint Working Group","volume":"86","author":"JCS\/JHRS 2020 Guideline on Pharmacotherapy of Cardiac Arrhythmias","year":"2022","journal-title":"Circulation Journal"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(84)90025-0"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.15911"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1053\/euhj.2001.2658"},{"issue":"14","key":"e_1_2_10_10_1","first-page":"e471","article-title":"2015 ACC\/AHA\/HRS Guideline for the Management of Adult Patients with Supraventricular Tachycardia: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Evidence Review Committee Chair","volume":"133","author":"Page R. L.","year":"2016","journal-title":"Circulation"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.94.7.1613"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejps.2020.105385"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(97)00710-8"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2008.12.012"}],"container-title":["Pacing and Clinical Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70301","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/pace.70301","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70301","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T03:11:26Z","timestamp":1791256286000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pace.70301"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,21]]},"references-count":13,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/pace.70301"],"URL":"https:\/\/doi.org\/10.1111\/pace.70301","archive":["Portico"],"relation":{},"ISSN":["0147-8389","1540-8159"],"issn-type":[{"value":"0147-8389","type":"print"},{"value":"1540-8159","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,21]]},"assertion":[{"value":"2026-03-31","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-21","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}