Use of dofetilide in adult patients with atrial arrhythmias and congenital heart disease: A PACES collaborative study

Heart Rhythm. 2016 Oct;13(10):2034-9. doi: 10.1016/j.hrthm.2016.07.016. Epub 2016 Jul 17.

Abstract

Background: Arrhythmia management has become the major treatment challenge in adult patients with congenital heart disease (ACHD).

Objective: We sought to investigate the utility and safety profile of dofetilide for atrial arrhythmias in ACHD.

Methods: A retrospective chart review was performed. We included patients (age ≥18 years) with congenital heart disease who had atrial fibrillation (AF) or intra-atrial reentrant tachycardia treated with dofetilide.

Results: We identified 64 patients with a mean age at initiation of 42 ± 14 years. ACHD type included single ventricle (n = 19, 30%), transposition of the great arteries (n = 14, 22%), atrial septal defect (n = 9, 14%), tetralogy of Fallot (n = 8, 12%), atrioventricular canal defect (n = 5, 8%), mitral/aortic stenosis (n = 7, 11%), and other (n = 2, 3%). Thirty-five (55%) had atrial fibrillation, and 29 (45%) had intra-atrial reentrant tachycardia. A total of 3 (4.7%) patients had major inpatient adverse events: torsades de pointes (n = 1, 1.5%), ventricular tachycardia (n = 1, 1.5%), and corrected QT prolongation requiring discontinuation (n = 1, 1.5%). Dofetilide was discontinued in 1 patient because of sinus node dysfunction, and another patient discontinued therapy before discharge because of persistent arrhythmia. Of the patients who were discharged on dofetilide (n = 59, 92%), 40 (68%) had adequate rhythm control and 19 (32%) had partial rhythm control. After a median follow-up of 3 years, 29 (49%) patients remained on dofetilide and 2 (3%) patients died. Reasons for discontinuation included waning effect (n = 16, 57%), side effects (n = 5, 18%), noncompliance (n = 2, 7%), successful ablation (n = 3, 11%), high cost (n = 1, 3.5%), and unknown (n = 1, 3.5%).

Conclusion: Dofetilide remains a viable antiarrhythmic drug option in this challenging population. At 3 years, 49% remained on dofetilide. Close monitoring of renal function, concomitant medications, and corrected QT interval is required.

Keywords: Atrial fibrillation; Congenital heart disease; Dofetilide; Intra-atrial reentrant tachycardia; Torsades de pointes; Ventricular tachycardia.

MeSH terms

  • Adult
  • Anti-Arrhythmia Agents / administration & dosage
  • Anti-Arrhythmia Agents / adverse effects
  • Atrial Fibrillation* / diagnosis
  • Atrial Fibrillation* / drug therapy
  • Atrial Fibrillation* / etiology
  • Drug Monitoring / methods
  • Drug Monitoring / statistics & numerical data
  • Electrocardiography / methods
  • Female
  • Heart Defects, Congenital* / classification
  • Heart Defects, Congenital* / complications
  • Heart Defects, Congenital* / epidemiology
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Outcome and Process Assessment, Health Care
  • Phenethylamines* / administration & dosage
  • Phenethylamines* / adverse effects
  • Retrospective Studies
  • Sulfonamides* / administration & dosage
  • Sulfonamides* / adverse effects
  • Tachycardia, Atrioventricular Nodal Reentry* / diagnosis
  • Tachycardia, Atrioventricular Nodal Reentry* / drug therapy
  • Tachycardia, Atrioventricular Nodal Reentry* / etiology
  • United States / epidemiology
  • Withholding Treatment / statistics & numerical data

Substances

  • Anti-Arrhythmia Agents
  • Phenethylamines
  • Sulfonamides
  • dofetilide