Clinical Significance of Serum Bepridil Concentration for Safe Rhythm Control Strategy in Patients with Atrial Tachyarrhythmias

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The aim of this study was to evaluate the clinical significance of the serum Bepridil (Bep) concentration (SBC) for safely managing patients with atrial tachyarrhythmias (AT). <B>Methods and Results:</B> SBC was measured in 41 patients with AT. The patients were administrated Bep for more than 4 weeks at same dose. They were divided into 2 groups according to their SBC: a high-SBC group (HSBC) of 11 patients with an SBC>500 ng/ml or a low-SBC group (LSBC) of 30 patients with an SBC<500 ng/ml. Age, underlying heart disease, cardiac function, dose of Bep did not differ between groups. Only the QT interval was significantly longer in the HSBC than in the LSBC (0.50±0.09 vs. 0.43±0.05, p=0.0067). Patients with QT >0.5 were more prominent in the HSBC (36% vs. 6.3%, p=0.014) and torsade de points (TdP) occurred in only one patient in the HSBC. <B>Conclusions:</B> In patients treated with Bep, measurement of SBC appears to be useful for preventing proarrhythmias. Patients with a high SBC but a normal QT interval may have a latent risk for QT prolongation and TdP when bradycardia or low potassium occurs. Reduction of Bep dose should be considered in such patients for the safe management.