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The purpose of this study is to clarify the efficacy and safety of bepridil for persistent atrial fibrillation (AF).Method Bepridil (100-200mg/day) was administered to 159 patients (141 males, 58 years) with persistent AF. The effects of conversion and maintenance of sinus rhythm (SR) were evaluated. If sinus restoration was not obtained until 3 months observation, DC cardioversion was performed. Results In 87 of 159 patients (55%), SR was restored within an average 2.1 months following administration of bepridil. 74 of those 87 patients (85%) have been maintained in SR for the average follow-up of 16 months. The 31 out of remaining 72 patients failed pharmacological conversion were performed DC cardioversion. All of patients restored SR, and 18 of them (58%) could be maintained SR for an average of 20 months. Although ECG revealed significant prolongation of QT interval from 0.38 to 0.42 sec, QTc was unchanged and no serious adverse complications including torsade de pointes were recognized. Conclusion Bepridil is clinically safe and useful with favorable efficacy for conversion and maintenance of SR in patients with persistent AF. [ABSTRACT FROM PUBLISHER]

A 14 year-old boy was admitted for evaluation of recurrent syncope. His ECG on admission revealed a sinus rhythm with an undetermined QRS axis, T wave inversion in leads V3, V4 and abnormal q leads I, aVL, V5 and V6. However, no underlying disease could be detected by any morphological examination. Programmed ventricular stimulation also induced no ventricular tachycardia or fibrillation (VF). Only signal-averaged ECG showed ventricular late potential and the cause of syncope was not clarified. As his brother with similar ECG had died suddenly, he was prophylactically treated with an ICD. However, 14 month later he died suddenly after playing a video game. The ICD recorded VF, which was not converted despite 6 cardioversion attempts by the ICD with 30 J. Progression of myocardial damages and/or elevation of defibrillation threshold may have been the cause of unsuccessful cardioversion. [ABSTRACT FROM PUBLISHER]

We have observed 3 cases of Brugada like ECG findings after the resection of esophageal cancer. Case 1. A 63 years-old male who had atrial fibrillation (AF) was diagnosed as affected byesophageal cancer and underwent the resection of esophagus with subsequent reconstruction using stomach into retro-sternum. Post-operative ECG showed coved type ST elevation in lead V1-4. This finally gradually reverted in ten days after operation and normalized within 2 weeks. Case 2. A 69 year-old male, who had paroxysmal AF and esophageal cancer, received the same procedure as in case 1. His ECG revealed abnormal ST elevation in V1. In thoracic CT image, right ventricle (RV) was compressed by the reconstructed stomach. Case 3. A 68 year-old male underwent the same operation as described above. His post-operative ECG showed Brugada like ST elevation in V1-3. This ST change disappeared within 3 weeks. In none of these 3 cases, there was a family history of sudden death or syncope, and the previous ECG showed no ST segment elevation. The compression of the RV by lifted stomach was considered to induce the precordial ST elevation mimicking Brugada syndrome. [ABSTRACT FROM PUBLISHER]

Electrocardiographic changes were evaluated retrospectively in five patients without previous episodes of syncope or ventricular fibrillation who developed abnormal ST segment elevation mimicking the Brugada syndrome in leads V1-V3 after the administration of class Ic antiarrhythmic drugs. Pilsicainide (four patients) or flecainide (one patient) were administered orally for the treatment of symptomatic paroxysmal atrial fibrillation or premature atrial contractions. The QRS duration, QTc, and JT intervals on 12 lead surface ECG before administration of these drugs were all within normal range. After administration of the drugs, coved-type ST segment elevation in the right precordial leads was observed with mild QRS prolongation, but there were no apparent changes in JT intervals. No serious arrhythmias were observed during the follow up periods. Since ST segment elevation with mild QRS prolongation was observed with both pilsicainide and flecainide, strong sodium channel blocking effects in the depolarisation may have been the main factors responsible for the ECG changes. As the relation between ST segment elevation and the incidence of serious arrhythmias has not yet been sufficiently clarified, electrocardiographic changes should be closely monitored whenever class Ic drugs are given. [ABSTRACT FROM AUTHOR]