Manocha Pankaj, Bavikati Venkata, Langberg Jonathan, Lloyd Michael S
Department of Cardiac Electrophysiology, Emory University Hospital, Atlanta, Georgia 30322, USA.
Pacing Clin Electrophysiol. 2012 Feb;35(2):170-3. doi: 10.1111/j.1540-8159.2011.03245.x. Epub 2011 Oct 20.
Dofetilide, a class III antiarrhythmic, is one of the few alternatives to amiodarone in patients with atrial fibrillation (AF) and heart failure or coronary artery disease (CAD). While amiodarone has been extensively studied, little is known about predictors of response to dofetilide. We sought to identify clinical parameters associated with dofetilide success in a large cohort of patients with AF.
METHODS/RESULTS: A total of 287 patients with AF started on dofetilide between 2001 and 2008 were included. Dofetilide was deemed "completely effective" if the patient remained on dofetilide at follow-up and had no recurrences of AF clinically or by electrocardiogram. Dofetilide efficacy was analyzed in relation to clinical variables relevant to AF and AF recurrence. After a follow-up of 10.2 ± 7.7 months, 54.7% of the patients remained on dofetilide and it was completely effective in 26.8%. The discontinuation rate during initial hospitalization was 13.3% from excessive QT prolongation and one patient with torsades de pointes (successfully treated). A history of CAD was the only univariate predictor of efficacy (odds ratio [OR] 2.27, 95% confidence interval [CI] 1.29-4.01, P < 0.05). CAD remained the only significant factor associated with efficacy of dofetilide in a multivariate regression model (OR 2.01, 95% CI 1.11-3.70, P < 0.05, n = 270). The overall efficacy of dofetilide in patients with CAD was 41.1%, compared to 23.5% in those without CAD (P < 0.05).
In this large cohort of patients with AF, underlying coronary disease was significantly associated with dofetilide success. This finding may have utility for clinical decisions regarding initiation of dofetilide.
多非利特是一种III类抗心律失常药物，是心房颤动（AF）合并心力衰竭或冠状动脉疾病（CAD）患者中少数可替代胺碘酮的药物之一。虽然胺碘酮已得到广泛研究，但关于多非利特反应的预测因素却知之甚少。我们试图在一大群AF患者中确定与多非利特治疗成功相关的临床参数。
方法/结果：纳入了2001年至2008年间开始使用多非利特的287例AF患者。如果患者在随访时仍在使用多非利特且临床上或心电图上无AF复发，则多非利特被视为“完全有效”。分析了多非利特疗效与AF及AF复发相关临床变量的关系。经过10.2±7.7个月的随访，54.7%的患者仍在使用多非利特，其中26.8%完全有效。初次住院期间因QT间期过度延长停药率为13.3%，1例患者发生尖端扭转型室速（治疗成功）。CAD病史是疗效的唯一单因素预测指标（优势比[OR]2.27，95%置信区间[CI]1.29 - 4.01，P < 0.05）。在多因素回归模型中，CAD仍然是与多非利特疗效相关的唯一显著因素（OR 2.01，95% CI 1.11 - 3.70，P < 0.05，n = 270）。CAD患者中多非利特的总体疗效为41.1%，无CAD患者为23.5%（P < 0.05）。
在这一大群AF患者中，潜在的冠状动脉疾病与多非利特治疗成功显著相关。这一发现可能有助于指导多非利特起始治疗的临床决策。
