In Brugada syndrome, spontaneous augmentation of ST elevation in daily life occurred along with an increase in vagal activity. ST elevation was augmented more in patients with VF than in those without VF under similar vagal tone.

DM promoted atrial structural remodeling via the activation of the AGEs-RAGE system with upregulating CTGF. The inhibition of AGEs formation could be a novel upstream therapeutic approach for diabetes-related atrial fibrosis.

No abstract

Enalapril suppressed atrial pacing-induced AF with tachycardia-mediated cardiomyopathy by suppressing interstitial fibrosis, connexin43 over-expression and conduction delay.

harmacological termination by class I antiarrhythmic drugs is usually considered effective treatment for atrial fibrillation (AF) lasting only several days, but of little help for long-lasting AF. As AF progresses from paroxysmal to persistent, changes in the relative importance of AF mechanisms occur such as increasing substratemediated factors and decreasing triggering factors. Hence, in patients with long lasting AF, rhythm control therapy is abandoned and rate control therapy is selected as standard therapy. 1,2 However, we have previously demonstrated that oral administration of bepridil alone or in combination with aprindine restored sinus rhythm in 69% of 32 patients with long-lasting persistent AF (>3 months), 3 and we speculate that bepridil inhibits substrate-mediated factors and aprindine suppresses trigger-mediated factors. Bepridil hydrochloride, a diarylaminopropylamine derivative, was introduced as an anti-anginal agent. In addition to its Ca antagonist properties, it prolongs action potential duration and refractory periods of normal ventricular and atrial myocardium 4 by inhibiting several types of K current including rapid, slow and ultra rapid components of delayed rectifier K current. 5,6 Amiodarone has multi-channel blocking properties similar to bepridil and is effective in not only terminating long-lasting AF, but also maintaining sinus rhythm. 7 In a canine model of AF, amiodarone prevented down-regulation of the L-type Ca channel and increased fibrillation cycle length (FCL) through reversal of atrial remodeling. 8 In our previous study, termination of long-lasting AF with oral administration of bepridil was associated with a 30% increase in FCL, 2 and it is possible that bepridil is effective for not only termination of AF but also perpetuation of sinus rhythm. In the present study, we assessed the efficacy of pharmacological or electrical conversion in patients with long-lasting AF for recovery of atrial mechanical function and maintenance of sinus rhythm with respect to changes in FCL. Methods SubjectsAll 38 patients in the study group had had AF lasting at least 1 month, quantified by ECG, and the median was 5 months (range: 1-84 months). All patients underwent phys- Background The aim of this study was to evaluate pharmacological cardioversion of long-lasting persistent atrial fibrillation (AF) using bepridil in terms of recovery of atrial mechanical function and maintenance of sinus rhythm. Bepridil alone or in combination with aprindine is effective for termination of persistent AF. Methods and ResultsThe study group comprised 38 consecutive patients (24 men, 58.8±9.3 years) with successful conversion of persistent AF lasting >1 month either pharmacologically (Group I) or electrically (Group II). Fast Fourier transform analysis of fibrillation waves was performed and fibrillation cycle length (FCL) was calculated from the peak frequency. In Group I, sinus rhythm was pharmacologically restored in 22 patients after an average 30 days (7-49 days) of bepridil administration, either al...