Carvedilol is Effective and Safe in Combination With Bepridil for Persistent Atrial Fibrillation and Decreases the QT Prolongation Induced by Bepridil Therapy

Abstract

We investigated the efficacy of carvedilol for preventing the recurrence of atrial fibrillation and reducing QT prolongation induced by bepridil. We assigned 144 subjects with persistent atrial fibrillation. The subjects were divided into 3 groups: carvedilol plus bepridil, candesartan plus bepridil, and bepridil alone. The primary endpoint was length of time to the recurrence of atrial fibrillation. All subjects were followed up for 3 years. Electrocardiographic parameters were measured for QT interval, QTc, heart rate, and QRS duration. The pharmacological conversion rate by carvedilol plus bepridil was 77%, candesartan plus bepridil was 63%, and bepridil alone was 57%. The significant difference was between carvedilol plus bepridil and bepridil alone (P = 0.03). The maintenance of SR at 3 years was 60% in carvedilol plus bepridil, 59% in candesartan plus bepridil, and 40% in bepridil alone. The difference between carvedilol plus bepridil and bepridil alone was statistically significant (P = 0.04). QTc and QT interval were significantly prolonged in candesartan plus bepridil and bepridil alone but not in carvedilol plus bepridil. The authors demonstrated that the combination therapy with carvedilol plus bepridil is more effective for maintaining SR than bepridil alone therapy and carvedilol reduced QT prolongation by bepridil therapy.