Importance of morphological changes in T-U waves during bepridil therapy as a predictor of ventricular arrhythmic event

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Abstract

Background: Although bepridil is a useful anti-arrhythmic agent for atrial fibrillation, the appearance of serious ventricular arrhythmia, such as torsades de pointes, might be a problem. In this study, T-U wave morphology was evaluated during bepridil therapy and was examined as a predictor of ventricular arrhythmic events. Methods and Results: The study population consisted of 113 patients on bepridil therapy. They were divided into 2 groups with and without ventricular arrhythmic events. Morphological changes in T-U waves were analyzed in leads V2-5. During bepridil treatment, the QTc interval was prolonged from 0.45±0.01 to 0.49±0.01 s1/2 in all patients (P<0.0001) and any type of T-U wave change (fused U, slurred, bifid, biphasic or negative) appeared in 73% of event-free and 100% of event groups. In univariate analysis, QTc interval before bepridil (P=0.028), a wide QRS complex (P=0.042) before bepridil, biphasic (P=0.027) or negative (P=0.002) T-U waves in the stable phase, and the new appearance of biphasic (P=0.004) or negative (P<0.0001) T-U waves exhibited significant differences. In multivariate analysis, only newly appeared negative T-U wave exhibited a significant difference (odds ratio 10.13, 95% confidence interval = 0.031-2.302, P=0.041). Conclusions: In patients with stable bepridil treatment, a change in T-U wave morphology might be a useful predictor of ventricular arrhythmia assisting the QT interval.

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Kurokawa, S., Niwano, S., Kiryu, M., Murakami, M., Ishikawa, S., Yumoto, Y., … Izumi, T. (2010). Importance of morphological changes in T-U waves during bepridil therapy as a predictor of ventricular arrhythmic event. Circulation Journal, 74(5), 876–884. https://doi.org/10.1253/circj.CJ-09-0937

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