Dofetilide for atrial arrhythmias in congenital heart disease: a multicenter study.
BACKGROUND
Very little is known about use of the class III antiarrhythmic dofetilide in patients with congenital heart disease (CHD).


METHODS
A multicenter retrospective review of experience with dofetilide in CHD patients was undertaken.


RESULTS
Twenty adults with CHD and refractory atrial arrhythmias were treated with dofetilide at four institutions over a 7-year period. Three (15%) experienced adverse effects during in-hospital initiation of dofetilide (two with torsade de pointes, one with excessive QTc prolongation) and were not continued on this therapy. The remaining 17 were discharged taking dofetilide, with either resolved or improved arrhythmia. One was lost to follow-up. Five subsequently discontinued dofetilide due to waning effectiveness, manifest by recurrence of their arrhythmias. Eleven (55%) remained on dofetilide at most recent visit, with a median follow-up of nearly 1 year. Seven of these 11, or 35% of the CHD patients originally started on dofetilide, experienced a complete resolution of their arrhythmia. The remaining four had breakthrough episodes of atrial arrhythmia, but remained on dofetilide. No patient experienced torsade de pointes after the in-hospital initiation period.


CONCLUSIONS
Used appropriately, dofetilide appears to be a viable adjunct to catheter-based ablation and alternative pharmacological approaches for the treatment of atrial arrhythmias in adult patients with congenital heart disease.
Wells
Ronald
R
Division of Pediatric Cardiology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA.
Khairy
Paul
P
Harris
Louise
L
Anderson
C Christian
CC
Balaji
Seshadri
S
D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000209:etiology*; D002170:Canada; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D010627:Phenethylamines / Q000008:administration & dosage*; D012189:Retrospective Studies; D013449:Sulfonamides / Q000008:administration & dosage*; D016896:Treatment Outcome; D014481:United States
D000889:Anti-Arrhythmia Agents; D010627:Phenethylamines; D013449:Sulfonamides; C063533:dofetilide