Current Strategy of Anti- Arrhythmic Drug Therapy for Persistent Atrial Fibrillation

Persistent atrial fibrillation (AF) is quite difficult to convert to sinus rhythm by spontaneous or pharmacological means. Although electrical conversion or catheter ablation may be an alternative therapy choice, some patients do not find these invasive treatments acceptable. If aiming for pharmacological sinus conversion, amiodarone has been mainly chosen despite its limited efficacy. In contrast, bepridil, which is only available as an anti-arrhythmic drug in Japan, is known to have a superior defibrillation effect against persistent AF. According to recent clinical reports, bepridil achieves more than approximately 60% of the sinus conversion rate for persistent AF. The high maintenance effect of sinus rhythm after pharmacological or electrical conversion has also been confirmed. In addition, bepridil helps prevent the recurrence of AF even after catheter ablation. A concern with bepridil is the adverse complication of QT prolongation and subsequent-occurrence of torsades de pointes due to strong potassium channel blocking effects. Although scrupulous attention is always required for follow-up, bepridil could be a unique choice of drug among those drugs on the current therapeutic scene for patients with persistent AF.