title: Combination therapy of cilostazol and bepridil suppresses recurrent ventricular fibrillation related to J-wave syndromes.
abstract: BACKGROUND
  Brugada syndrome and idiopathic ventricular fibrillation (VF) associated with inferolateral early repolarization patterns are termed "J-wave syndromes." In such patients, an implantable cardioverter-defibrillator (ICD) is first-line therapy for prevention of sudden cardiac death. However, frequent ICD shocks due to recurrent VF remain serious problems.
  
  
  OBJECTIVE
  The purpose of this study was to ascertain if combination therapy of cilostazol and bepridil could suppress recurrent VF.
  
  
  METHODS
  We enrolled 7 patients with J-wave syndromes who experienced ICD shocks due to recurrent VF after ICD implantation. At first, cilostazol was instituted. In all subjects, palpitations due to sinus tachycardia caused by cilostazol were symptomatic. Addition of bepridil attenuated cilostazol-induced palpitations and maintained the suppressive effect of cilostazol against VF (87 ± 12 bpm to 66 ± 7 bpm, P < .01).
  
  
  RESULTS
  Six patients remained free of VF. Three patients underwent replacement of the ICD generator 4-5 years after ICD placement. Cilostazol was discontinued 2 days before replacement because of its antiplatelet effects. In all 3 patients, temporary discontinuation of cilostazol led to the reappearance of J waves, culminating in VF and an appropriate ICD shock in 1 patient. J waves disappeared with reinstitution of cilostazol.
  
  
  CONCLUSIONS
  These data suggest that combination therapy of cilostazol and bepridil may be effective and safe in suppressing VF recurrence in some cases of J-wave syndromes.
authors.affiliation: Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan. Electronic address: shinohar@oita-u.ac.jp.
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Shinohara
authors.affiliation: Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Ebata
authors.affiliation: Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan.
authors.forename: Reika
authors.initials: R
authors.lastname: Ayabe
authors.affiliation: Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Fukui
authors.affiliation: Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Okada
authors.affiliation: Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan.
authors.forename: Kunio
authors.initials: K
authors.lastname: Yufu
authors.affiliation: Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan.
authors.forename: Mikiko
authors.initials: M
authors.lastname: Nakagawa
authors.affiliation: Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan.
authors.forename: Naohiko
authors.initials: N
authors.lastname: Takahashi
mesh_terms: D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage; D015764:Bepridil / Q000008:administration & dosage*; D000077407:Cilostazol; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D058987:Phosphodiesterase 3 Inhibitors / Q000008:administration & dosage; D012008:Recurrence; D013777:Tetrazoles / Q000008:administration & dosage*; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000188:drug therapy* / Q000503:physiopathology; D055815:Young Adult
chemical_list: D000889:Anti-Arrhythmia Agents; D058987:Phosphodiesterase 3 Inhibitors; D013777:Tetrazoles; D015764:Bepridil; D000077407:Cilostazol
keywords: Bepridil; Cilostazol; J-wave syndrome; Ventricular fibrillation