Key result
The addition of bepridil to class I antiarrhythmic drugs effectively reduced symptomatic episodes or restored sinus rhythm in 76% of patients with drug-refractory atrial fibrillation.
Why the study?
Does the addition of bepridil to class I antiarrhythmic drugs improve rhythm control and reduce symptoms in patients with refractory atrial fibrillation?
Observational (n=76)
No
Does the addition of bepridil to class I antiarrhythmic drugs improve rhythm control and reduce symptoms in patients with refractory atrial fibrillation?
The addition of bepridil to class I antiarrhythmic drugs is an effective and safe strategy for restoring and maintaining sinus rhythm in patients with refractory atrial fibrillation, provided QT intervals are closely monitored.
May aid refractory AF rhythm control; leaves open randomized confirmation before practice change.
BACKGROUND: Bepridil has multiple ion-channel blocking effects and is expected to be useful for managing atrial fibrillation (AF). The purpose of this study was to clarify the efficacy and safety of additional treatment with bepridil in patients with AF who had been treated with class I antiarrhythmic drugs (AADs). METHODS AND RESULTS: Bepridil (50-200 mg/day) was given to 76 patients with either paroxysmal (n=49) or persistent AF (n=27). All patients had been treated with class I AADs (1.9+/-0.9 drugs/patient) that failed to control the AF. With the addition of bepridil, the frequency of symptomatic AF episodes decreased to less than 10% in 38 (78%) patients with paroxysmal AF, and sinus rhythm was restored within 3 months and maintained during the follow-up in 20 (74%) patients with persistent AF. Efficacy was usually obtained with a small to moderate dose (50-150 mg/day) of bepridil. During a mean follow-up period of 27+/-22 months, no potential complications occurred in any of the patients. CONCLUSIONS: The addition of bepridil to class I AADs is effective and safe for AF, but careful observation using periodic ECG recordings is essential for avoiding torsades de pointes caused by QT prolongation.
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Miyaji et al. (2007) conducted an observational in Atrial fibrillation refractory to class I antiarrhythmic drugs (n=76). Bepridil added to class I antiarrhythmic drugs was evaluated on >90% reduction in symptomatic AF episodes (paroxysmal) or restoration and maintenance of sinus rhythm (persistent). The addition of bepridil to class I antiarrhythmic drugs effectively reduced symptomatic episodes or restored sinus rhythm in 76% of patients with drug-refractory atrial fibrillation.
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