title: Carvedilol is effective and safe in combination with bepridil for persistent atrial fibrillation and decreases the QT prolongation induced by bepridil therapy.
abstract: BACKGROUND
  We investigated the efficacy of carvedilol for preventing the recurrence of atrial fibrillation and reducing QT prolongation induced by bepridil.
  
  
  METHODS
  We assigned 144 subjects with persistent atrial fibrillation. The subjects were divided into 3 groups: carvedilol plus bepridil, candesartan plus bepridil, and bepridil alone. The primary endpoint was length of time to the recurrence of atrial fibrillation. All subjects were followed up for 3 years. Electrocardiographic parameters were measured for QT interval, QTc, heart rate, and QRS duration.
  
  
  RESULTS
  The pharmacological conversion rate by carvedilol plus bepridil was 77%, candesartan plus bepridil was 63%, and bepridil alone was 57%. The significant difference was between carvedilol plus bepridil and bepridil alone (P = 0.03). The maintenance of SR at 3 years was 60% in carvedilol plus bepridil, 59% in candesartan plus bepridil, and 40% in bepridil alone. The difference between carvedilol plus bepridil and bepridil alone was statistically significant (P = 0.04). QTc and QT interval were significantly prolonged in candesartan plus bepridil and bepridil alone but not in carvedilol plus bepridil.
  
  
  CONCLUSIONS
  The authors demonstrated that the combination therapy with carvedilol plus bepridil is more effective for maintaining SR than bepridil alone therapy and carvedilol reduced QT prolongation by bepridil therapy.
authors.affiliation: Division of Cardiology, Showa University School of Medicine, Tokyo, Japan. mitsuhitoharu@yahoo.co.jp
authors.forename: Mitsuharu
authors.initials: M
authors.lastname: Kawamura
authors.forename: Yumi
authors.initials: Y
authors.lastname: Munetsugu
authors.forename: Kaoru
authors.initials: K
authors.lastname: Tanno
authors.forename: Youichi
authors.initials: Y
authors.lastname: Kobayashi
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D001562:Benzimidazoles / Q000627:therapeutic use; D015764:Bepridil / Q000009:adverse effects / Q000627:therapeutic use*; D001713:Biphenyl Compounds; D002227:Carbazoles / Q000009:adverse effects / Q000627:therapeutic use*; D000077261:Carvedilol; D018572:Disease-Free Survival; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008133:Long QT Syndrome / Q000139:chemically induced / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011412:Propanolamines / Q000009:adverse effects / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D055502:Secondary Prevention; D013777:Tetrazoles / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D002227:Carbazoles; D011412:Propanolamines; D013777:Tetrazoles; D000077261:Carvedilol; D015764:Bepridil; C081643:candesartan