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Dofetilide for Atrial Arrhythmias in Congenital Heart Disease: A Multicenter Study
Author(s) -
WELLS RONALD,
KHAIRY PAUL,
HARRIS LOUISE,
ANDERSON C. CHRISTIAN,
BALAJI SESHADRI
Publication year - 2009
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2009.02479.x
Subject(s) - dofetilide , medicine , cardiology , heart disease , qt interval , herg , adverse effect , anesthesia , potassium channel
Background: Very little is known about use of the class III antiarrhythmic dofetilide in patients with congenital heart disease (CHD).Methods: A multicenter retrospective review of experience with dofetilide in CHD patients was undertaken.Results: Twenty adults with CHD and refractory atrial arrhythmias were treated with dofetilide at four institutions over a 7‐year period. Three (15%) experienced adverse effects during in‐hospital initiation of dofetilide (two with torsade de pointes, one with excessive QTc prolongation) and were not continued on this therapy. The remaining 17 were discharged taking dofetilide, with either resolved or improved arrhythmia. One was lost to follow‐up. Five subsequently discontinued dofetilide due to waning effectiveness, manifest by recurrence of their arrhythmias. Eleven (55%) remained on dofetilide at most recent visit, with a median follow‐up of nearly 1 year. Seven of these 11, or 35% of the CHD patients originally started on dofetilide, experienced a complete resolution of their arrhythmia. The remaining four had breakthrough episodes of atrial arrhythmia, but remained on dofetilide. No patient experienced torsade de pointes after the in‐hospital initiation period.Conclusions: Used appropriately, dofetilide appears to be a viable adjunct to catheter‐based ablation and alternative pharmacological approaches for the treatment of atrial arrhythmias in adult patients with congenital heart disease.