Observations on the safety and effectiveness of dofetilide in patients with paroxysmal atrial fibrillation and normal left ventricular function.
Dofetilide is currently recommended as second-tier therapy to maintain sinus rhythm in patients with paroxysmal atrial fibrillation (PAF) and normal left ventricular function, yet limited data support this recommendation. We examined the safety and efficacy of dofetilide in this setting through a retrospective chart review. We evaluated patients who had symptomatic PAF, normal left ventricular function, and no significant valvular disease. The end points were complete suppression of symptomatic PAF and subjective symptomatic improvement with dofetilide treatment. Over a 3-year period, 34 patients who had failed previous antiarrhythmic therapy were included. Of these, 3 discontinued dofetilide treatment before discharge. Of the remaining 31 who continued treatment after discharge, it was eventually discontinued in 13. At 12 months, symptomatic improvement was observed in 18 of 31 patients, 6 of whom remained asymptomatic. Treatment with dofetilide in this study was successful in less than 1 in 5 patients. Despite careful precautions, serious proarrhythmias, the major limiting side effect of dofetilide, still occurred during long-term follow-up.
Mykytsey
Andrew
A
Advocate Illinois Masonic Medical Center, 3000 N. Halsted Street, Chicago, IL 60612, USA.
Bauman
Jerry L
JL
Razminia
Mansour
M
Zheutlin
Terry
T
Wang
Ted
T
Saleem
Mohammad
M
Leal
Sergio
S
Kehoe
Richard F
RF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D001282:Atrial Flutter / Q000139:chemically induced; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D005424:Flecainide / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D007297:Inpatients; D008133:Long QT Syndrome / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D010627:Phenethylamines / Q000009:adverse effects / Q000627:therapeutic use*; D011405:Propafenone / Q000627:therapeutic use; D012008:Recurrence; D013015:Sotalol / Q000627:therapeutic use; D013449:Sulfonamides / Q000009:adverse effects / Q000627:therapeutic use*; D017180:Tachycardia, Ventricular / Q000139:chemically induced; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects*; D028761:Withholding Treatment / Q000706:statistics & numerical data
D000889:Anti-Arrhythmia Agents; D010627:Phenethylamines; D013449:Sulfonamides; D011405:Propafenone; D013015:Sotalol; D005424:Flecainide; D000638:Amiodarone; C063533:dofetilide