Bepridil for recurrent sustained ventricular tachycardias: assessment using electrophysiologic testing

Area of Science:

• Cardiology
• Electrophysiology
• Pharmacology

Background:

• Recurrent sustained ventricular tachycardia (VT) poses a significant therapeutic challenge.
• Existing antiarrhythmic agents, including amiodarone, may be ineffective in some patients.
• Bepridil exhibits electrophysiologic properties of both Class I and Class IV antiarrhythmic drugs.

Purpose of the Study:

• To evaluate the efficacy and safety of bepridil in patients with recurrent sustained VT.
• To assess both intravenous and oral administration of bepridil.
• To determine bepridil's potential as an alternative therapy for refractory VT.

Main Methods:

• Serial electrophysiologic studies were conducted in 9 patients with drug-refractory VT.
• Intravenous bepridil was administered to 6 patients, followed by oral bepridil in others.
• Programmed electrical stimulation assessed VT inducibility and characteristics before and after bepridil treatment.

Main Results:

• Intravenous bepridil terminated VT in 3 of 6 patients and prevented its initiation in 2 others.
• Oral bepridil therapy prevented VT initiation in 66% of patients.
• Long-term oral treatment was successful in 5 of 6 patients, with 3 remaining symptom-free for 4-13 months.
• Adverse effects, including paralytic ileus, necessitated drug discontinuation in one patient.

Conclusions:

• Bepridil demonstrates significant potential in managing recurrent sustained ventricular tachycardia.
• The drug's ability to terminate and prevent VT suggests a valuable role in refractory cases.
• Further investigation into bepridil's long-term efficacy and safety profile is warranted.