Banchs Javier E, Baquero Giselle A, Nickolaus Michelle J, Wolbrette Deborah L, Kelleman John J, Samii Soraya, Grando-Ting Jennifer, Penny-Peterson Erica, Davidson William R, Young Sallie K, Naccarelli Gerald V, Gonzalez Mario D
Penn State Hershey Heart & Vascular Institute, Penn State University, Hershey, Pa, USA.
Congenit Heart Dis. 2014 May-Jun;9(3):221-7. doi: 10.1111/chd.12129. Epub 2013 Aug 15.
Atrial tachyarrhythmias (AT) including atrial fibrillation (AF), atrial flutter (AFL), and atrial tachycardia represent a clinical challenge in the adult with congenital heart disease (CHD). Dofetilide (D) is a rapidly activating delayed rectifier potassium channel (IKr) blocker effective in pharmacological conversion and maintenance of normal sinus rhythm in patients with AF and AFL. There is limited knowledge regarding the role of D in adults with CHD.
Safety and efficacy of D was evaluated in a consecutive group of thirteen adult patients (age 40 ± 11; six women) with CHD and refractory AT.
Ten patients had persistent (four AFL, one AF, and five atrial tachycardia) and three paroxysmal (one AF and two atrial tachycardia) AT. All patients were symptomatic during tachycardia, 12 patients had previously failed 2 ± 1 antiarrhythmic drugs. Mean systemic ventricular ejection fraction was 55 ± 9%; baseline QRS complex duration was 129 ± 45 ms (>120 ms in six patients). Patients were followed on D for 33 ± 39 months (median 16). Among 10 patients with persistent AT, seven patients (70%) pharmacologically converted to sinus rhythm on D and three patients (30%) required direct current cardioversion. Two patients (15.4%) experienced complete arrhythmia suppression, and seven (53.8%) experienced significant clinical improvement with sporadic recurrences; average time to recurrence was 5.5 ± 3.5 months. One patient developed torsade de pointes during loading, and the drug was discontinued. D was discontinued in five (38.5%) other patients due to recurrence of AT (n = 4) and renal failure (n = 1). Corrected QT interval (QTc) increased from 452 ± 61 to 480 ± 49 ms (P = .04) and corrected JT interval (JTc) from 323 ± 39 to 341 ± 33 ms (P = .09).
D should be considered a pharmacologic alternative when adult patients with CHD develop AT. D does not depress conduction, sinus node, or ventricular function but needs close monitoring for potential ventricular pro-arrhythmia.
包括心房颤动（AF）、心房扑动（AFL）和房性心动过速在内的房性快速心律失常是先天性心脏病（CHD）成人患者面临的临床挑战。多非利特（D）是一种快速激活延迟整流钾通道（IKr）阻滞剂，对房颤和房扑患者的药物复律及维持正常窦性心律有效。关于多非利特在先天性心脏病成人患者中的作用，目前了解有限。
对连续入选的13例先天性心脏病合并难治性房性快速心律失常的成年患者（年龄40±11岁；6例女性）评估多非利特的安全性和有效性。
10例患者为持续性房性快速心律失常（4例房扑、1例房颤和5例房性心动过速），3例为阵发性房性快速心律失常（1例房颤和2例房性心动过速）。所有患者在心动过速发作时均有症状，12例患者之前使用2±1种抗心律失常药物治疗失败。平均全身心室射血分数为55±9%；基线QRS波群时限为129±45 ms（6例患者>120 ms）。患者接受多非利特治疗33±39个月（中位数16个月）。在10例持续性房性快速心律失常患者中，7例（70%）通过药物治疗转为窦性心律，3例（30%）需要直流电复律。2例患者（15.4%）心律失常完全得到抑制，7例（53.8%）临床症状显著改善，偶有复发；平均复发时间为5.5±3.5个月。1例患者在负荷给药期间发生尖端扭转型室速，药物停用。另外5例患者（38.5%）因房性快速心律失常复发（4例）和肾衰竭（1例）停用多非利特。校正QT间期（QTc）从452±61 ms增至480±49 ms（P=0.04），校正JT间期（JTc）从323±39 ms增至341±33 ms（P=0.09）。
先天性心脏病成年患者发生房性快速心律失常时，应考虑将多非利特作为一种药物治疗选择。多非利特不抑制传导、窦房结或心室功能，但需要密切监测潜在的室性心律失常。
