title: Correlation between inflammation state and successful medical cardioversion using bepridil for refractory atrial fibrillation.
abstract: BACKGROUND
  It has been reported that inflammation is associated with long-term maintenance of sinus rhythm after electrical cardioversion for non-valvular atrial fibrillation (AF). However, the relation between high-sensitive C-reactive protein (hs-CRP) and the recurrence of AF after medical cardioversion is unknown. On the other hand, bepridil is very effective in restoring sinus rhythm for patients with refractory AF.
  
  
  RESULTS
  In 119 patients with non-valvular AF lasting >6 months who failed to maintain sinus rhythm after medical cardioversion without bepridil or electrical cardioversion, we prescribed bepridil. We divided our patients into success group who maintained sinus rhythm for at least 6 months using bepridil and failure group, and compared the following parameters, which were measured just before prescription of bepridil, between the two groups: hs-CRP as a marker of inflammation, left ventricular end-diastolic dimension, ejection fraction, and left atrial dimension as echocardiographic markers, and the incidence of dyslipidemia, hypertension, and diabetes mellitus. After the treatment with bepridil, 57 patients converted to sinus rhythm; however, 12 patients among these 57 patients could not maintain sinus rhythm. Therefore, the success group consisted of 45 patients (38%). Univariate analysis revealed that left atrial dimension and the value of hs-CRP were significantly lower and ejection fraction was significantly higher in the success group than the failure group. Multivariate analysis showed that hs-CRP and left atrial dimension were independent factors for AF recurrence.
  
  
  CONCLUSIONS
  Bepridil is effective in restoring sinus rhythm for refractory AF patients. Inflammation, in addition to left atrial dimension, may be associated with successful cardioversion using bepridil.
authors.affiliation: Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan. mnishino@orh.go.jp
authors.forename: Masami
authors.initials: M
authors.lastname: Nishino
authors.forename: Naoki
authors.initials: N
authors.lastname: Mori
authors.forename: Daisuke
authors.initials: D
authors.lastname: Nakamura
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Lee
authors.forename: Takahiro
authors.initials: T
authors.lastname: Yoshimura
authors.forename: Masayuki
authors.initials: M
authors.lastname: Taniike
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Makino
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Kato
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Egami
authors.forename: Ryu
authors.initials: R
authors.lastname: Shutta
authors.forename: Jun
authors.initials: J
authors.lastname: Tanouchi
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Yamada
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D015764:Bepridil / Q000008:administration & dosage*; D015415:Biomarkers / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis*; D004554:Electric Countershock; D005260:Female; D006325:Heart Atria / Q000473:pathology; D006339:Heart Rate; D006801:Humans; D007249:Inflammation / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012849:Sinoatrial Node / Q000503:physiopathology; D013318:Stroke Volume; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D015415:Biomarkers; D015764:Bepridil; D002097:C-Reactive Protein
keywords: Atrial fibrillation; Bepridil; Cardioversion; Inflammation