Patterns of Dofetilide Use for the Treatment of Atrial Fibrillation

Patterns of dofetilide use for rhythm control in atrial fibrillation (AF) have not been well elucidated.The purpose of this study was to characterize dofetilide use on initiation at an academic medical center.Retrospective data on consecutive patients admitted for dofetilide initiation at our institution from 2004 to 2009 were abstracted.Dofetilide initiations were assessed with respect to concordance with the tiered maintenance of sinus rhythm (MSR) algorithm for anti-arrhythmic drug (AAD) use outlined in the 2011 AHA/ACC/HRS guidelines for the management of AF.Follow-up data were collected through November 2012.A total of 122 patients were included.The mean age was 62±13 years.Females constituted 34% (42/122) of the cohort.Eighty patients (66%) were in AF at the time of admission.In patients with no prior AAD exposure (56/122; 46%), dofetilide use was significantly more discordant with the 2011 MSR guidelines than for patients in whom dofetilide was used as a second-line agent (46% discordant versus 15% discordant, po0.001).Rates of chemical cardioversion with dofetilide were significantly higher among patients in whom it was used as a second-line agent (53% versus 29%, p ¼ 0.026).The average duration of dofetilide therapy for patients in whom dofetilide was their first AAD was 787 days.The rate of discontinuation of dofetilide during the initial admission was 19%.Dofetilide use discordant from the 2011 MSR guidelines was high, particularly in patients for whom dofetilide was chosen as first-line AAD therapy.Dofetilide persistency appears high relative to other AADs.