Journal article
Use of dofetilide in adult patients with atrial arrhythmias and congenital heart disease: A PACES collaborative study
Heart rhythm, Vol.13(10), pp.2034-2039
10/2016
DOI: 10.1016/j.hrthm.2016.07.016
PMID: 27435587
Abstract
Arrhythmia management has become the major treatment challenge in adult patients with congenital heart disease (ACHD).
We sought to investigate the utility and safety profile of dofetilide for atrial arrhythmias in ACHD.
A retrospective chart review was performed. We included patients (age ≥18 years) with congenital heart disease who had atrial fibrillation (AF) or intra-atrial reentrant tachycardia treated with dofetilide.
We identified 64 patients with a mean age at initiation of 42 ± 14 years. ACHD type included single ventricle (n = 19, 30%), transposition of the great arteries (n = 14, 22%), atrial septal defect (n = 9, 14%), tetralogy of Fallot (n = 8, 12%), atrioventricular canal defect (n = 5, 8%), mitral/aortic stenosis (n = 7, 11%), and other (n = 2, 3%). Thirty-five (55%) had atrial fibrillation, and 29 (45%) had intra-atrial reentrant tachycardia. A total of 3 (4.7%) patients had major inpatient adverse events: torsades de pointes (n = 1, 1.5%), ventricular tachycardia (n = 1, 1.5%), and corrected QT prolongation requiring discontinuation (n = 1, 1.5%). Dofetilide was discontinued in 1 patient because of sinus node dysfunction, and another patient discontinued therapy before discharge because of persistent arrhythmia. Of the patients who were discharged on dofetilide (n = 59, 92%), 40 (68%) had adequate rhythm control and 19 (32%) had partial rhythm control. After a median follow-up of 3 years, 29 (49%) patients remained on dofetilide and 2 (3%) patients died. Reasons for discontinuation included waning effect (n = 16, 57%), side effects (n = 5, 18%), noncompliance (n = 2, 7%), successful ablation (n = 3, 11%), high cost (n = 1, 3.5%), and unknown (n = 1, 3.5%).
Dofetilide remains a viable antiarrhythmic drug option in this challenging population. At 3 years, 49% remained on dofetilide. Close monitoring of renal function, concomitant medications, and corrected QT interval is required.
Details
- Title: Subtitle
- Use of dofetilide in adult patients with atrial arrhythmias and congenital heart disease: A PACES collaborative study
- Creators
- Iqbal El-Assaad - Department of Pediatrics, Cleveland Clinic Children's, Cleveland, OhioSadeer G Al-Kindi - Harrington Heart & Vascular Institute, University Hospitals Case Medical Center & Case Western Reserve University, Cleveland, OhioJoEllyn Abraham - Minneapolis Heart Institute, Abbott Northwestern Hospital,, Minneapolis, MinnesotaShubhayan Sanatani - Children's Heart Centre, BC Children's Hospital, University of British Columbia, Vancouver, CanadaDavid J Bradley - Michigan Congenital Heart Center, University of Michigan, Ann Arbor, MichiganColby Halsey - Cardiovascular Center, University of Michigan, Ann Arbor, MichiganIan H Law - Division of Pediatric Cardiology, University of Iowa Children's Hospital, Iowa City, IowaSeshadri Balaji - Division of Pediatric Cardiology, Oregon Health and Science University, Portland, OregonIra Shetty - Division of Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, IllinoisPeter F Aziz - Division of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio. Electronic address: azizp@ccf.org
- Resource Type
- Journal article
- Publication Details
- Heart rhythm, Vol.13(10), pp.2034-2039
- DOI
- 10.1016/j.hrthm.2016.07.016
- PMID
- 27435587
- ISSN
- 1547-5271
- eISSN
- 1556-3871
- Language
- English
- Date published
- 10/2016
- Academic Unit
- Cardiology; Stead Family Department of Pediatrics
- Record Identifier
- 9984093354602771
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