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 (Mpro) of SARS-CoV-2 plays an indispensable role.3 Previously, Vatansever et al. reported that bepridil hydrochloride inhibits the enzymatic activity of Mpro 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. doi: 10.19102/icrm.2022.130601. [CrossRef] [PubMed] [DOI] [PMC free article] [PubMed] [Google Scholar]
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