Bepridil Might be Potent Against the Coronavirus Disease 2019–related Electrical Storm in Brugada Syndrome

DOI: 10.19102/icrm.2022.13106

AKINORI HIGAKI, MD, PhD¹

¹Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Japan

Download PDF

Follow Us >> Tweet

KEYWORDS. Bepridil, Brugada syndrome, COVID-19, electrical storm.

The author report no conflicts of interest for the published content. No funding information was provided.
Manuscript received July 24, 2022. Final version accepted July 26, 2022.
Address correspondence to: Akinori Higaki, MD, PhD, Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, Japan. Email: higaki.akinori.cf@ehime-u.ac.jp.

I read with great interest the case report by Ali and Nilsson on electrical storm in Brugada syndrome (BrS) induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.¹ While experts have already made thoughtful comments on this issue,² I would like to add an idea for treatment options that was not mentioned during the discussion: bepridil.

In the viral replication process, the main protease (M^pro) of SARS-CoV-2 plays an indispensable role.³ Previously, Vatansever et al. reported that bepridil hydrochloride inhibits the enzymatic activity of M^pro in vitro, suggesting a potential antiviral effect in coronavirus disease 2019 (COVID-19).⁴ To date, bepridil has also been reported to be effective in the prevention of electrical storm in BrS.⁵ Therefore, the electrical storm reported by Ali and Nilsson might have been prevented if the patient was prescribed bepridil.

I am aware that bepridil is currently only available in limited countries (i.e., China, France, and Japan) because of its QT-prolongation side effect. However, I believe it is worthwhile to discuss possible treatment options for patients whose lives are at grave risk in the COVID-19 era.

References

1. Ali SH, Nilsson KR. Electrical storm in a patient with Brugada syndrome and coronavirus disease 2019 infection. J Innov Card Rhythm Manag. 2022;13(6):5019–5023. [CrossRef] [PubMed]
2. Brugada P, Wu C-I, Wilde AAM, Baranchuk A, Alexander B, Miranda-Arboleda AF. Exploring coronavirus disease 2019 and Brugada syndrome. J Innov Card Rhythm Manag. 2022;13(6):5025–5028. [CrossRef] [PubMed]
3. Jin Z, Du X, Xu Y, Deng Y, Liu M, Zhao Y, et al. Structure of Mpro from SARS-CoV-2 and discovery of its inhibitors. Nature. 2020;582(7811):289–293. [CrossRef] [PubMed]
4. Vatansever EC, Yang KS, Drelich AK, Kratch KC, Cho CC, Kempaiah KR, et al. Bepridil is potent against SARS-CoV-2 in vitro. Proc Natl Acad Sci U S A. 2021;118(10):e2012201118. [CrossRef] [PubMed]
5. Kaneko Y, Horie M, Niwano S, Kusano KF, Takatsuki S, Kurita T, et al. Electrical storm in patients with Brugada syndrome is associated with early repolarization. Circ Arrhythmia Electrophysiol. 2014;7(6):1122–1128. [CrossRef] [PubMed]