Key result
Dofetilide achieved pharmacological conversion to sinus rhythm in 70% of adult patients with congenital heart disease and persistent refractory atrial tachyarrhythmias.
Why the study?
Does dofetilide improve arrhythmia suppression and clinical symptoms in adults with congenital heart disease and refractory atrial tachyarrhythmias?
Observational (n=13)
Does dofetilide improve arrhythmia suppression and clinical symptoms in adults with congenital heart disease and refractory atrial tachyarrhythmias?
Dofetilide may be an effective pharmacological alternative for treating refractory atrial tachyarrhythmias in adults with congenital heart disease, though close monitoring for ventricular pro-arrhythmia is required.
Answers are grounded in this paper and cite their sources.
May support dofetilide consideration in refractory ACHD arrhythmias with monitoring; hypothesis-generating and requires prospective validation.
BACKGROUND: Atrial tachyarrhythmias (AT) including atrial fibrillation (AF), atrial flutter (AFL), and atrial tachycardia represent a clinical challenge in the adult with congenital heart disease (CHD). Dofetilide (D) is a rapidly activating delayed rectifier potassium channel (IKr) blocker effective in pharmacological conversion and maintenance of normal sinus rhythm in patients with AF and AFL. There is limited knowledge regarding the role of D in adults with CHD. METHODS: Safety and efficacy of D was evaluated in a consecutive group of thirteen adult patients (age 40 ± 11; six women) with CHD and refractory AT. RESULTS: Ten patients had persistent (four AFL, one AF, and five atrial tachycardia) and three paroxysmal (one AF and two atrial tachycardia) AT. All patients were symptomatic during tachycardia, 12 patients had previously failed 2 ± 1 antiarrhythmic drugs. Mean systemic ventricular ejection fraction was 55 ± 9%; baseline QRS complex duration was 129 ± 45 ms (>120 ms in six patients). Patients were followed on D for 33 ± 39 months (median 16). Among 10 patients with persistent AT, seven patients (70%) pharmacologically converted to sinus rhythm on D and three patients (30%) required direct current cardioversion. Two patients (15.4%) experienced complete arrhythmia suppression, and seven (53.8%) experienced significant clinical improvement with sporadic recurrences; average time to recurrence was 5.5 ± 3.5 months. One patient developed torsade de pointes during loading, and the drug was discontinued. D was discontinued in five (38.5%) other patients due to recurrence of AT (n = 4) and renal failure (n = 1). Corrected QT interval (QTc) increased from 452 ± 61 to 480 ± 49 ms (P = .04) and corrected JT interval (JTc) from 323 ± 39 to 341 ± 33 ms (P = .09). CONCLUSIONS: D should be considered a pharmacologic alternative when adult patients with CHD develop AT. D does not depress conduction, sinus node, or ventricular function but needs close monitoring for potential ventricular pro-arrhythmia.
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Banchs et al. (2013) conducted an observational in Congenital heart disease and refractory atrial tachyarrhythmias (n=13). Dofetilide was evaluated on Pharmacological conversion to sinus rhythm in patients with persistent atrial tachyarrhythmias. Dofetilide achieved pharmacological conversion to sinus rhythm in 70% of adult patients with congenital heart disease and persistent refractory atrial tachyarrhythmias.
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