The relationship between the plasma concentration of bepridil and its efficacy in the treatment of atrial fibrillation in Japanese patients.

Bepridil hydrochloride is used for treatment of atrial fibrillation (AF) in Japan. We investigated the relationship between plasma concentrations of bepridil just before dosing (Cbep) and its clinical efficacy in Japanese patients (n=36) with AF. Patients were treated orally with 100, 150 or 200 mg/d bepridil. Cbep were measured with UV-HPLC. In the first 14 d, when 150, 200, 250 or 300 ng/mL was set as a boundary value, the efficacy of bepridil was significantly higher in all patients with Cbep above than below the boundary value (p<0.05). In the maintenance stage (3 months longer after starting therapy), the efficacy of bepridil was significantly higher in patients with Cbep above than below 300 ng/mL (p=0.04). The clinical efficacy of bepridil was closely related to Cbep. The target value of Cbep to obtain a clinical benefit was approximately 300 ng/mL. Monitoring Cbep should be useful in the treatment of patients with AF.

An LC method for quantifying bepridil in human plasma using 1-naphthol as the internal standard.

A modified method for the quantitative determination of bepridil hydrochloride in human plasma is described. This method is unrelated to chemical methods currently in use. The mobile phase is 50 mM phosphate buffer (pH3.0)-methanol-acetonitrile-triethylamine (57:3:40:1, v/v), and the samples are fractionated on a C8-3 column (150 × 4.6 mm, 5 µm) using a flow rate of 0.9 mL/min. Bepridil was detected by UV spectroscopy at 254 nm. The retention times of bepridil and 1-naphthol were 12.6 min and 7.5 min, respectively; there was no interference originating from human plasma. We confirmed that the bepridil and 1-naphthol peaks were not influenced by the presence of 32 commercial medicines frequently co-administered with bepridil. Additionally, the concentration of bepridil in the plasma of five patients treated with bepridil for atrial fibrillation was measured. These samples were collected just before each dosage of bepridil. Their rhythm and rate control were well maintained. Trough concentrations ranged from 233.9 to 347.4 ng/mL, similar to previously reported values.

Iodine-123-metaiodobenzylguanidine scintigraphy of total cardiac adrenergic denervation in Brugada syndrome.

A 22-year-old Japanese man with Brugada syndrome was resuscitated from cardiopulmonary arrest. In addition to the electrocardiographic evidence of the syndrome and the absence of apparent structural heart disease, no accumulation of iodine-123-metaiodobenzylguanidine (MIBG) was found anywhere throughout the heart. Thallium-201 (Tl) single photon emission computed tomography (SPECT) distribution showed no significant decrease in its uptake. To our knowledge, this is the first report that has demonstrated a homogeneous absence of cardiac accumulation of MIBG in Brugada syndrome.