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Electrophysiologic effects of bepridil in patients with refractory ventricular tachycardia assessed by programmed
C Schmitt1, J Brachmann, C Hölzel
1Department of Cardiology, University of Heidelberg, Federal Republic of Germany.
Abstract:
The effect of intravenous bepridil, a new calcium antagonist with class I and III properties, was tested in 21 patients with sustained ventricular tachyarrhythmias refractory to a mean of five antiarrhythmic agents as assessed by programmed right ventricular stimulation. At control electrophysiologic study without antiarrhythmic agents, sustained monomorphic ventricular tachycardia (VT) was initiated in 20 patients and ventricular fibrillation (VF) was initiated in one patient. After 3 mg/kg of bepridil was administered, VT was still inducible in 19 patients (3 patients had self-terminating VT); the other 2 patients had no inducible VT after bepridil. Bepridil prolonged significantly the QTc interval, the effective refractory period, and the cycle length of induced ventricular tachycardia. Two patients with no inducible VT after intravenous bepridil were placed on oral bepridil (300 mg/day). One patient died suddenly and one patient died of progressive heart failure. The results seem to indicate that the efficacy of bepridil in patients with refractory ventricular tachycardia is limited.
Insights
Bepridil, a calcium antagonist, showed limited efficacy for refractory ventricular tachycardia. While it prolonged heart rhythms, it did not prevent inducible arrhythmias in most patients, suggesting limited clinical benefit.
Area of Science:
- Cardiology
- Clinical Electrophysiology
Background:
- Ventricular tachyarrhythmias (VT) pose a significant challenge, often requiring multiple antiarrhythmic agents.
- Bepridil is a calcium antagonist with Class I and III antiarrhythmic properties.
Purpose of the Study:
- To evaluate the efficacy of intravenous bepridil in patients with sustained ventricular tachyarrhythmias refractory to conventional therapy.
Main Methods:
- Twenty-one patients with refractory ventricular tachyarrhythmias underwent electrophysiologic studies.
- Programmed right ventricular stimulation was used to assess inducibility of VT/VF before and after intravenous bepridil (3 mg/kg).
Main Results:
- Intravenous bepridil failed to prevent inducible VT in 19 out of 21 patients.
- Bepridil significantly prolonged the QTc interval, effective refractory period, and VT cycle length.
- Two patients with initially suppressed VT died during follow-up (one sudden death, one heart failure).
Conclusions:
- Intravenous bepridil demonstrates limited efficacy in suppressing inducible ventricular tachyarrhythmias in this refractory patient population.
- The observed proarrhythmic effects and limited efficacy suggest caution in using bepridil for such conditions.