Open AccessSafety of Outpatient Initiation of Disopyramide for Obstructive Hypertrophic Cardiomyopathy Patients
Author(s) -
Adler Ar,
Fourey Dana,
WeisslerSnir Adaya,
Hindieh Waseem,
Chan Raymond H.,
Gollob Michael H.,
Rakowski Harry
Publication year - 2017
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.116.005152
Subject(s) - medicine , hypertrophic cardiomyopathy , disopyramide , cardiology , cardiomyopathy , obstructive cardiomyopathy , heart failure , intensive care medicine
Background Disopyramide is effective in ameliorating symptoms in patients with hypertrophic cardiomyopathy; however, its potential for proarrhythmic effect has raised concerns about its use in the ambulatory setting. The risk of initiating disopyramide in this manner has never been evaluated. Methods and Results All charts of patients seen in the outpatient hypertrophic cardiomyopathy clinic between 2010 and 2014 were screened for initiation of disopyramide and data were extracted. Disopyramide in our clinic is usually initiated at a dose of 300 mg daily and titrated during follow‐up. A total of 2015 patients were seen in the clinic, including 168 who were started on disopyramide. There were no cardiac events within 3 months of disopyramide initiation. During long‐term follow‐up (255 patient‐years; mean, 447 days; interquartile range, 201–779), only 2 patients developed cardiac events (syncope of unknown cause in both). Thirty‐eight patients (23%) developed side effects of disopyramide and 18 (11%) stopped the drug because of these side effects. Of the patients continuing disopyramide long term, 63% remained free of septal reduction interventions at end of follow‐up. Disopyramide at a dose of 300 mg prolonged the mean QT c interval by 19±23 ms; however, increasing the dose to 600 mg had no further significant effect. Conclusions Initiation of disopyramide in the outpatient setting is safe and the risk of subsequent sudden cardiac death is low. Because of its QT ‐prolonging effect, precautions may be necessary in patients at higher risk of torsades de pointes.