Dofetilide for the treatment of premature ventricular complexes and ventricular tachycardia in patients with structural heart disease.
Background: Dofetilide is a class III antiarrhythmic agent approved for the treatment of atrial fibrillation and atrial flutter. Given the efficacy of other class III agents, it has been used off‐label for the treatment of premature ventricular complexes (PVCs) and ventricular tachycardias (VTs). Ob...
| Publicado en: | Journal of Cardiovascular Electrophysiology Vol. 35; no. 12; pp. 2363 - 2372 |
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| Autores principales: | , , , , , , , , , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Dec2024
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=181701919&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 181701919 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10453873 GSB jtl: Journal of Cardiovascular Electrophysiology issn: 10453873 maglogo: Y pubinfo: dt: Dec2024 vid: 35 iid: 12 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 181701919 180060220 181701919 181701919 10.1111/jce.16452 181701919 ppf: 2363 ppct: 9 formats: fmt: – @attributes: type: T – @attributes: type: C – @attributes: type: P tig: atl: Dofetilide for the treatment of premature ventricular complexes and ventricular tachycardia in patients with structural heart disease. aug: au: Deshmukh, Amrish Yokokawa, Miki McBride, Daniel Simpson, Jamie Chou, Andrew Ghannam, Michael Liang, Jackson J. Saeed, Mohammed Cunnane, Ryan Ghanbari, Hamid Latchamsetty, Rakesh Crawford, Thomas Jongnarangsin, Krit Pelosi, Frank Chugh, Aman Morady, Fred Bogun, Frank Oral, Hakan affil: Division of Cardiovascular Medicine, Cardiac Arrhythmia Service, University of Michigan, Ann Arbor Michigan,, USA sug: subj: Dofetilide Therapeutic Use Premature Ventricular Contractions Drug Therapy Tachycardia, Ventricular Drug Therapy Heart Defects, Congenital Drug Efficacy Evaluation Patient Safety Evaluation Human Cardiac Patients Male Female Middle Age Aged Retrospective Design Record Review Prospective Studies Inpatients Defibrillators, Implantable Dofetilide Adverse Effects Treatment Failure Treatment Withdrawal Recurrence Heart Transplantation Premature Ventricular Contractions Mortality Tachycardia, Ventricular Mortality Premature Ventricular Contractions Prognosis Tachycardia, Ventricular Prognosis Log-Rank Test Comparative Studies Middle Aged: 45-64 years Aged: 65+ years Male Female ab: Background: Dofetilide is a class III antiarrhythmic agent approved for the treatment of atrial fibrillation and atrial flutter. Given the efficacy of other class III agents, it has been used off‐label for the treatment of premature ventricular complexes (PVCs) and ventricular tachycardias (VTs). Objective: The purpose of this study was to determine the efficacy and safety of dofetilide for ventricular arrythmias (VAs). Methods: In this retrospective cohort study, 81 patients (59 men; age = 60 ± 14 years; LVEF = 0.34 ± 0.16) were admitted for dofetilide initiation to treat PVCs (29), VTs (42) or both (10). A ≥ 80% decrease in PVC burden was defined as a satisfactory response. An ICD was present in 72 patients (89%). Another antiarrhythmic was previously used in 50 patients (62%). Prior catheter ablation had been performed in 33 patients (41%). Results: During intitiation, dofetilide was discontinued in 12 patients (15%) due to QT prolongation (8) and inefficacy to suppress VAs (4). Among the 32 patients with PVCs who successfully started dofetilide, the mean PVC burden decreased from 20 ± 10% to 8 ± 8% at a median follow‐up of 2.6 months (p <.001). PVC burden was reduced by ≥80% in only 11/32 patients (34%). During 7 ± 1 years of follow‐up, 41/69 patients (59%) continued to have VAs and received appropriate ICD therapies for monomorphic VTs (35) and polymorphic VT/VF (6) at a median of 8.0 (IQR 2.6–33.2) months. Dofetilide had to be discontinued in 50/69 patients (72%) due to inefficacy or intolerance. The composite outcome of VT/VF recurrence, heart transplantation, or death occurred in 6/12 patients (50%) without dofetilide and 49/69 patients (71%) with dofetilide. The event free survival was similar between patients treated with and without dofetilide (log‐rank p =.55). Conclusions: Treatment with dofetilide was associated with a decrease in PVCs, however clinically significant suppression occurred in a minority of patients. Dofetilide failed to suppress the occurrence of VTs in a majority of patients. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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