Pharmacological Conversion of Persistent Atrial Fibrillation Into Sinus Rhythm With Oral Pilsicainide

Okishige, Kaoru; Fukunami, Masatake; Kumagai, Koji; Atarashi, Hirotsugu; Inoue, Hiroshi

doi:10.1253/circj.70.657

Cited by 21 publications

(10 citation statements)

References 31 publications

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“…Anti-arrhythmic effects of pilsicainide on AF have been clinically recognized (Okishige et al 2006;Horiuchi et al 2009). The main mechanism of anti-fibrillation of sodium channel blockers is attributed to ERP prolongation through an enhancement of post-repolarization refractoriness (Kanki et al 1998;Kirchhof et al 2005).…”

Section: Potential Anti-fibrillatory Effects Of Pilsicainidementioning

confidence: 99%

A Sodium Channel Blocker, Pilsicainide, Produces Atrial Post-Repolarization Refractoriness through the Reduction of Sodium Channel Availability

Fukuda

Watanabe

Yagi

et al. 2011

Tohoku J. Exp. Med.

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Atrial fibrillation (AF) is the most common tachyarrhythmia. Shortening of atrial action potential duration (APD) and effective refractory period (ERP) is one of the crucial factors in the occurrence and maintenance of AF. ERP is usually shorter than APD, but ERP can be prolonged beyond action potential repolarization in some situations. It is termed as post-repolarization refractoriness (PRR) that is thought to be one of main anti-arrhythmic mechanisms of class I sodium channel blockers (SCBs). Most of anti-arrhythmic agents, including SCBs, have multi-channel blocking effects. It is unknown whether atrial PRR with SCBs is associated with the reduction of sodium channel availability. We therefore explored the relationship between the reduction of sodium channel availability with a pure SCB (pilsicainide or tetrodotoxin) and atrial PRR using the left atrial appendage from male guinea pigs (each group, n = 3~10). Employing a standard microelectrode technique, we evaluated APD measured at 90% repolarization (APD 90 ) and the sodium channel availability, judged from the maximal rate of rise of action potential (Vmax). At a 500-msec basic cycle length (BCL), pilsicainide prolonged atrial ERP assessed by a single extra-stimulus in response to the decrement of the Vmax in a dose-dependent manner without affecting APD 90 . Furthermore, pilsicainide increased the ERP and decreased the Vmax in a rate-dependent manner without APD 90 prolongation at a shorter BCL (200 msec). Importantly, tetrodotoxin reproduced the effects of pilsicainide on atrial ERP, APD 90 , and Vmax. These results indicate that SCBs produce atrial PRR through the reduction of sodium channel availability.

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Section: Potential Anti-fibrillatory Effects Of Pilsicainidementioning

confidence: 99%

A Sodium Channel Blocker, Pilsicainide, Produces Atrial Post-Repolarization Refractoriness through the Reduction of Sodium Channel Availability

Fukuda

Watanabe

Yagi

et al. 2011

Tohoku J. Exp. Med.

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“…On the other hand, the rate of successful pharmacological cardioversion (PC) of PEF by class I drugs is not very high compared with class III drugs. 8 Bepridil was originally developed as an antianginal drug. Besides calcium channel blocking properties, it has multiple ion-channel blocking effects.…”

Section: Introductionmentioning

confidence: 99%

Pharmacological cardioversion preceding left atrial ablation: bepridil predicts the clinical outcome following ablation in patients with persistent atrial fibrillation

et al. 2009

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“…550 In a clinical trial of oral pilsicainide 150 mg/day, the defibrillation rate was lower in cases of AF lasting ≥2 weeks and in cases of left atrial diameter ≥45 mm. 551 Flecainide and sotalol both failed to defibrillate AF in cases of AF lasting ≥7 days. 552 In this guideline, drug selection is described by setting the boundary as 7 days, at which time the effect of Na + channel blockers becomes weakened.…”

Section: ▋ 512 Persistent Atrial Fibrillationmentioning

confidence: 99%

JCS/JHRS 2020 Guideline on Pharmacotherapy of Cardiac Arrhythmias

Ono

Iwasaki

Akao

et al. 2022

Circ J

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Pharmacological Conversion of Persistent Atrial Fibrillation Into Sinus Rhythm With Oral Pilsicainide

Cited by 21 publications

References 31 publications

A Sodium Channel Blocker, Pilsicainide, Produces Atrial Post-Repolarization Refractoriness through the Reduction of Sodium Channel Availability

A Sodium Channel Blocker, Pilsicainide, Produces Atrial Post-Repolarization Refractoriness through the Reduction of Sodium Channel Availability

Pharmacological cardioversion preceding left atrial ablation: bepridil predicts the clinical outcome following ablation in patients with persistent atrial fibrillation

JCS/JHRS 2020 Guideline on Pharmacotherapy of Cardiac Arrhythmias

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