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Ventricular Ectopy and QTc‐Interval Prolongation Associated with Dronedarone Therapy
Author(s) -
Gonzalez Jaime E.,
Sauer William H.,
Krantz Mori J.
Publication year - 2013
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.1330
Subject(s) - dronedarone , medicine , amiodarone , qt interval , cardiology , atrial fibrillation , palpitations , anesthesia
Amiodarone is an effective treatment for atrial and ventricular arrhythmias, but its use is limited by a toxic adverse‐effect profile. Although dronedarone has been touted as an antiarrhythmic agent devoid of both solid organ toxicity and proarrhythmic properties, its potential for prolonging ventricular repolarization may augment triggered ectopy. We describe a 66‐year‐old man who began dronedarone 400 mg twice/day for new‐onset paroxysmal atrial fibrillation; he had no left ventricular dysfunction or clinical heart failure. Three months after starting the drug, he complained of malaise, fatigue, and rare palpitations. Twenty four–hour Holter monitoring revealed increased premature ventricular complexes, and the rate‐corrected QT ( QT c) interval was prolonged (range 525–760 msec). Dronedarone was discontinued and the patient's symptoms gradually resolved over the next 3 weeks. Holter monitoring revealed a marked reduction in ventricular ectopy burden, and the QT c interval decreased to his baseline values. Even in the absence of documented symptomatic torsade de pointes, this case suggests that caution should be exercised when prescribing dronedarone and that serial QT c interval monitoring may be appropriate. In addition, clinicians should have a low threshold to perform Holter monitoring if symptoms develop during dronedarone therapy.