Bepridil is effective and improves QOL in multidrug-resistant paroxysmal atrial fibrillation.
OBJECTIVE
Efficacy and safety of long-term administration of bepridil as a rhythm and rate controller were comprehensively evaluated in patients with multidrug-resistant paroxysmal atrial fibrillation (PAF).


METHODS
A retrospective survey from 1992 to 2006 was conducted on 62 multidrug-resistant PAF patients treated with bepridil from 480 consecutive PAF patients. In addition, a 5-year follow-up study was conducted on 28 of the 62 patients, being continued from 2006 to 2011. The efficacy of bepridil, improvement in symptoms including patients' quality of life (QOL), ECGs, hemodynamics, and its adverse effects were examined.


RESULTS
In the retrospective survey, 127 ± 44 mg of bepridil was given for 21 ± 18 months and 40.3% maintained sinus rhythm. Reductions in the frequency and the duration of each episode of PAF and improvement in symptoms were seen in 48.4, 50.0 and 93.5% of the 62 patients, respectively. Reversible torsades de pointes (TdP) occurred in two aged women. Bradycardia and hepatic dysfunction developed in one patient each. In the follow-up study, 100 ± 20 mg of bepridil was given. Sinus rhythm was maintained in 13 patients. Although the occurrences of PAF continued in 14 patients, their symptoms and QOL were improved. No adverse effects were noted in all 28 patients of the follow-up study.


CONCLUSIONS
Bepridil was effective in rhythm control in 40% of PAF patients resistant to other antiarrhythmics. Even in those who had failed to maintain sinus rhythm, continued administration of low-dose bepridil improved their symptoms and QOL with few adverse effects. Bepridil is worth returning to use.
Department of Preventive Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
Atsushi
A
Shamoto
Akiko
A
Chishaki
Miyuki
M
Tsuchihashi-Makaya
Hiroaki
H
Chishaki
Masao
M
Takemoto
Yasushi
Y
Mukai
Shujiro
S
Inoue
Kenji
K
Sunagawa
D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D015764:Bepridil / Q000009:adverse effects / Q000627:therapeutic use*; D018432:Drug Resistance, Multiple; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; D015764:Bepridil