Top

Journal of Interventional Cardiac Electrophysiology

Published in:

01-11-2008

Efficacy and safety of dofetilide in patients with atrial fibrillation and atrial flutter

Authors: Javier E. Banchs, Deborah L. Wolbrette, Soraya M. Samii, Erica D. Penny-Peterson, Parag P. Patel, Sallie K. Young, Mario D. Gonzalez, Gerald V. Naccarelli

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 2/2008

Abstract

Background

Dofetilide, an I_Kr blocker has been demonstrated to be effective in terminating persistent atrial fibrillation and flutter (AF/AFL), and in maintaining sinus rhythm after direct current cardioversion (CV). It is not known, however, whether pharmacological conversion with dofetilide predicts maintenance of sinus rhythm. In addition, there is limited information comparing the efficacy of dofetilide in persistent versus paroxysmal AF/AFL.

Methods and Results

Eighty consecutive patients with AF/AFL (51 persistent, 29 paroxysmal) admitted for initiation of dofetilide were studied. Termination of persistent AF/AFL occurred in 61% of patients while 39% required CV. After 21 ± 19 months of follow-up, 37% of patients with persistent AF/AFL were free of recurrence. Acute conversion with dofetilide did not predict long term efficacy. Dofetilide was more effective in maintaining sinus rhythm in patients with AFL (65%) than in those with AF (25%) (p < 0.05). Dofetilide was more likely to maintain sinus rhythm in patients with persistent than paroxysmal AF/AFL (37 vs. 14%; p < 0.05). Torsades de Pointes developed in two patients despite careful dosing and monitoring of QT changes.

Conclusions

Dofetilide is more effective in patients with persistent than in those with paroxysmal AF/AFL. Importantly, short-term response does not necessarily predict long-term efficacy. Significant proarrhythmia can occur even with careful in-hospital monitoring.

Fuster, V., Ryden, L. E., Cannom, D. S., et al. (2006). ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American college of cardiology/American heart association task force on practice guidelines and the European society of cardiology committee for practice guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation). Circulation, 114, e257–e354.PubMedCrossRef

Gwilt, M., Arrowsmith, J. E., Blackburn, K. J., et al. (1991). UK-68,798: a novel, potent and highly selective class III antiarrhythmic agent which blocks potassium channels in cardiac cells. The Journal of Pharmacology and Experimental Therapeutics, 256, 318–324.PubMed

Mounsey, J. P., & DiMarco, J. P. (2000). Cardiovascular drugs. Dofetilide. Circulation, 102, 2665–2670.PubMed

Roukoz, H., & Saliba, W. (2007). Dofetilide: a new class III antiarrhythmic agent. Expert Review of Cardiovascular Therapy, 5(1), 9–19.PubMedCrossRef

Greenbaum, R. A. (1999). Meeting highlights: highlights of the 71st Scientific Sessions of the American Heart Association. The EMERALD trial. Circulation, 99, 2486–2491.

Singh, S., Zoble, R. G., Yellen, L., et al. (2000). Efficacy and safety of oral dofetilide in converting to and maintaining sinus rhythm in patients with chronic atrial fibrillation or atrial flutter: the symptomatic atrial fibrillation investigative research on defetilide (SAFIRE-D) study. Circulation, 102, 2385–2390.PubMed

Torp-Pedersen, C., Moller, M., Bloch-Thomsen, P. E., et al. (1999). Dofetilide in patients with congestive heart failure and left ventricular dysfunction. Danish Investigations of Arrhythmia and Mortality on Dofetilide Study Group. The New England Journal of Medicine, 341, 857–865.PubMedCrossRef

Kober, L., Bloch Thompsen, P. E., Moller, M., et al. (2000). Effect of dofetilide in patients with recent myocardial infarction and left ventricular dysfunction: a randomized trial. Lancet, 356, 2052–2058.PubMedCrossRef

Pedersen, O. D., Bagger, H., Keller, N., & Marchant, B. (2001). kober l, Torp-Pedersen C. Efficacy of dofetilide in the treatment of atrial fibrillation–flutter in patients with reduced left ventricular function: a Danish investigations of arrhythmia and mortality on dofetilide (diamond) substudy. Circulation, 104, 292–296.PubMed

10.

Prystowsky, E. N., Freeland, S., Branyas, N. A., et al. (2003). Clinical experience with dofetilide in the treatment of patients with atrial fibrillation. Journal of Cardiovascular Electrophysiology, 14, S287–S290.PubMedCrossRef

11.

Mykytsey, A., Bauman, J. L., Razminia, M., et al. (2007). Observations on the safety and effectiveness of dofetilide in patients with paroxysmal atrial fibrillation and normal left ventricular function. Journal of Cardiovascular Pharmacology and Therapeutics, 12, 36–43.PubMedCrossRef

12.

Cotiga, D., Arshad, A., Aziz, E., et al. (2007). Acute conversion of persistent atrial fibrillation during dofetilide initiation. Pacing and Clinical Electrophysiology, 30, 1527–1530.PubMed

13.

Feld, G. K., & Cha, Y. (1997). Electrophysiologic effects of the new class III antiarrhythmic drug dofetilide in an experimental canine model of pacing-induced atrial fibrillation. Journal of Cardiovascular Pharmacology and Therapeutics, 2(3), 195–203.PubMedCrossRef

14.

Tai, C. T., & Chen, S. A. (2001). Mechanisms of antiarrhythmic drug action on termination of atrial flutter. Pacing and Clinical Electrophysiology, 24, 824–834.PubMedCrossRef

15.

Falk, R. H., Pollak, A., Singh, S. N., et al. (1997). Intravenous dofetilide a class III antiarrhythmic agent, for the termination of sustained atrial fibrillation or flutter. Intravenous Dofetilide Investigators. Journal of the American College of Cardiology, 29(2), 385–390.PubMedCrossRef

16.

Stambler, B. S., Wood, M. A., & Ellenbogen, K. A. (1997). Antiarrhythmic actions of intravenous ibutilide compared with procainamide during human atrial flutter and fibrillation. Electrophysiological determinants of enhanced conversion efficacy. Circulation, 96, 4298–4306.PubMed

17.

Wirth, K. J., & Knobloch, K. (2001). Differential effects of dofetilide, amiodarone, and class Ic drugs on left and right atrial refractoriness and left atrial vulnerability in pigs. Naunyn-Schmiedeberg’s Archives of Pharmacology, 363, 166–174.PubMedCrossRef

18.

Knobloch, K., Brendel, J., Peukert, S., et al. (2002). Electrophysiological and antiarrhythmic effects of the novel Ikur channel blockers, S9947 and S20951, on left vs. right pig atrium in vivo in comparison with the IKr blockers dofetilide, azimilide, d,l-sotalol and ibutilide. Naunyn-Schmiedeberg’s Archives of Pharmacology, 366, 482–487.PubMedCrossRef

19.

Waldo, A. L. (2002). Mechanisms of atrial flutter and atrial fibrillation: distinct entities or two sides of a coin. Cardiovascular Research, 54, 216–229.CrossRef

20.

Waldo, A. L., & Feld, G. K. (2008). Inter-relationships of atrial fibrillation and atrial flutter. Journal of the American College of Cardiology, 51, 779–786.PubMedCrossRef

21.

Cappato, R., Calkins, H., Chen, S. A., et al. (2005). Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation, 111, 1100–1105.PubMedCrossRef

Title: Efficacy and safety of dofetilide in patients with atrial fibrillation and atrial flutter
Authors: Javier E. Banchs
Deborah L. Wolbrette
Soraya M. Samii
Erica D. Penny-Peterson
Parag P. Patel
Sallie K. Young
Mario D. Gonzalez
Gerald V. Naccarelli
Publication date: 01-11-2008
Publisher: Springer US
Published in: Journal of Interventional Cardiac Electrophysiology / Issue 2/2008
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI: https://doi.org/10.1007/s10840-008-9290-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Efficacy and safety of dofetilide in patients with atrial fibrillation and atrial flutter

Abstract

Background

Methods and Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods and Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2008

Prolonged inflation of coronary angioplasty balloon as treatment for subocclusive dissection of the coronary sinus during implantation of a coronary sinus pacing lead

Electrophysiological study and catheter ablation of a Mahaim fibre located at the mitral annulus–aorta junction

Venous valves within left ventricular coronary veins

Presence of left ventricular contractile reserve, evaluated by means of dobutamine stress-echo test, is able to predict response to cardiac resynchronization therapy

Successful transition to buprenorphine in a patient with methadone-induced torsades de pointes

Ablation of incessant orthodromic reciprocating tachycardia in a child with congenitally corrected transposition of great arteries and ebsteinoid malformation of left atrioventricular valve