Why the study?
AF management remains complex, and while dofetilide is an important rhythm control option safe in structural heart disease, its use is limited by safety and monitoring concerns.
Dofetilide is a highly selective class III antiarrhythmic that is safe and effective for rhythm control in AF patients with structural heart disease and HFrEF, provided strict protocol-driven inpatient initiation and QT monitoring are maintained.
Supports dofetilide for AF rhythm control in structural heart disease; extends prior syntheses with integrated safety and guideline context.
Atrial fibrillation is the most common sustained cardiac arrhythmia and is associated with significant morbidity, mortality, and healthcare burden worldwide. The management of AF remains complex, encompassing rate and rhythm control strategies, anticoagulation, and comorbidity optimization. Dofetilide, a class III antiarrhythmic agent, has emerged as an important therapeutic option for rhythm control due to its relatively selective blockade of the rapid component of the delayed rectifier potassium current (IKr). Unlike many other antiarrhythmics, it lacks significant negative inotropy, making it safe for use in patients with structural heart disease and left ventricular dysfunction. However, its use is limited by concerns regarding torsades de pointes, mandatory in-hospital initiation, and stringent monitoring requirements. This review provides a comprehensive analysis of dofetilide, including its pharmacology, clinical trial evidence, safety profile, guideline recommendations, role in special populations, real-world application in India, and future perspectives.
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Mahendru et al. (2025) studied this question.
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