Cardiovascular Center, Yokosuka Kyosai Hospital, Yonegahamadori 1-16, Yokosuka, Kanagawa, Japan.
Europace. 2009 Dec;11(12):1620-3. doi: 10.1093/europace/eup363. Epub 2009 Nov 11.
Bepridil is highly effective in terminating persistent atrial fibrillation (AF). Despite continued treatment, a high rate of AF recurrence after pharmacological cardioversion (PC) with bepridil has been reported. Bepridil therapy is also associated with significant adverse effects.
This retrospective case-control study included 82 patients with persistent AF (PEF). Group 1 (22 patients) comprised cases undergoing AF ablation following attempted PC with bepridil. Group 2 (60 patients) comprised control that underwent AF ablation without bepridil pre-treatment. In Group 1, 15 patients (68%) restored sinus rhythm (SR) with bepridil (SR group) and 7 continued to have AF (AF group). SR group underwent extensive pulmonary vein isolation (EPVI) alone. AF group and Group 2 underwent linear ablation after EPVI, if AF was inducible. At the end of 18 +/- 5 months off antiarrhythmic drugs, the AF-free rate was 87% in SR group, 29% in AF group, and 72% in Group 2 (72 vs. 29%, P = 0.02).
Following AF ablation in patients who successfully restored SR with bepridil pre-treatment, AF-free rate was significantly higher than in those who failed to do so. Conversion to SR with bepridil might help select the optimal patients with PEF for catheter ablation.
贝普地尔在终止持续性心房颤动（AF）方面非常有效。尽管持续治疗，但仍有报道称，贝普地尔进行药物复律（PC）后，AF 复发率很高。贝普地尔治疗还与显著的不良反应有关。
本回顾性病例对照研究纳入了 82 例持续性 AF（PEF）患者。第 1 组（22 例）包括在尝试使用贝普地尔进行 PC 后进行 AF 消融的病例。第 2 组（60 例）包括未接受贝普地尔预处理而进行 AF 消融的对照。在第 1 组中，15 例患者（68%）用贝普地尔恢复窦性心律（SR）（SR 组），7 例继续有 AF（AF 组）。SR 组仅进行广泛肺静脉隔离（EPVI）。AF 组和第 2 组在 EPVI 后，如果可诱发出 AF，则进行线性消融。在停用抗心律失常药物 18 +/- 5 个月后，SR 组的 AF 无复发率为 87%，AF 组为 29%，第 2 组为 72%（72%比 29%，P = 0.02）。
在成功用贝普地尔复律的患者中进行 AF 消融后，无 AF 复发率明显高于未成功复律的患者。用贝普地尔转为 SR 可能有助于选择 PEF 的最佳患者进行导管消融。
