The Second Department of Internal Medicine, Faculty of Medicine, Toyama University, Toyama, Japan.
Circ J. 2007;71 Suppl A:A69-74. doi: 10.1253/circj.71.a69.
Pharmacological therapy for atrial fibrillation (AF) is difficult because AF induces atrial remodeling. Randomized prospective studies using amiodarone could not show the superiority of rhythm control strategy to rate control strategy for treatment of AF. Bepridil is a multichannel blocker like amiodarone and expected to be effective for termination of AF without exacerbation of extracardiac adverse effects. Efficacy and safety of bepridil in pharmacological cardioversion of long-lasting AF (≥3 months) was assessed. To avoid the risk of excessive QT prolongation, bepridil dosage was limited to ≤200 mg/day and aprindine (class Ib) was added if necessary. Bepridil alone or in combination with aprindine restored sinus rhythm in 69% of patients. No adverse effects necessitating drug termination occurred. The average time to conversion after starting bepridil was 30 days and cardioversion was associated with significant increase in fibrillation cycle length. After cardioversion, atrial contraction recovered faster within 1 week and sinus rhythm was maintained better than conventional electrical cardioversion. The history of drug-resistant AF did not affect efficacy of bepridil. These observations suggest that pharmacological cardioversion of long-lasting AF could become a new therapeutic option. Although the precise mechanism of cardioversion by bepridil is not clear, reversal of the remodeled atria may play an important role.
房颤（AF）的药物治疗很困难，因为 AF 可引起心房重构。采用胺碘酮的随机前瞻性研究未能显示节律控制策略优于心率控制策略，用于 AF 的治疗。贝拉普利是一种多通道阻滞剂，类似于胺碘酮，有望有效终止 AF，而不会加重心脏外不良反应。评估了贝拉普利在治疗持续时间≥3 个月的长程 AF 中的药理转复效果。为避免 QT 间期延长的风险，将贝拉普利剂量限制在≤200mg/天，如果需要，可加用普鲁卡因胺（Ib 类）。贝拉普利单独或联合普鲁卡因胺可使 69%的患者恢复窦性节律。无因药物不良反应而停药的情况发生。开始使用贝拉普利后平均 30 天转复，转复与心房颤动周期长度显著增加相关。转复后，心房收缩在 1 周内恢复更快，且窦性节律维持优于传统的电转复。药物抵抗性 AF 的病史并不影响贝拉普利的疗效。这些观察结果表明，长程 AF 的药物转复可能成为一种新的治疗选择。尽管贝拉普利转复的精确机制尚不清楚，但对重构心房的逆转可能发挥重要作用。
