Hassan Virk Hafeez Ul, Qureshi Waqas T, Makkar Nayani, Bastawrose Joseph, Souvaliotis Nektarios, Aziz Joshua, Aziz Emad
ACAP Cardiac Research Program, Al-Sabah Arrhythmia Institute, Division of Cardiology, Mount Sinai St. Luke's and Mount Sinai West Hospitals, New York, New York.
Department of Cardiology, Wake Forest University, Winston-Salem, North Carolina.
Clin Cardiol. 2017 Jul;40(7):474-479. doi: 10.1002/clc.22680. Epub 2017 Mar 14.
Dofetilide is a class III antiarrhythmic prescribed to cardiovert persistent atrial fibrillation (AF) to sinus rhythm (SR).
To determine the clinical predictors of cardioversion and readmission in persistent AF patients on dofetilide.
We analyzed 160 patients with persistent AF who were started on dofetilide and followed for 1 year. We examined age, sex, race, hypertension, diabetes, smoking, dyslipidemia, CAD, left ventricular ejection fraction (LVEF), creatinine, BMI and concomitant use of calcium channel blockers (CCB), β-blockers in a multivariable logistic regression model. We also examined the same predictors in Cox regression model for AF-related readmission within 1 year of follow-up.
13.5% individuals did not convert to SR on dofetilide. 55.6% converted on the first dose and 83.1% converted by the fourth dose. In multivariable logistic models, dyslipidemia (OR: 2.4, CI: 1.12-5.16) and LVEF (OR: 3.83,CI: 1.37-10.8) were associated with failure to convert with the first dose. Female sex and LVEF also were associated with increased risk of failure to convert at all. Concomitant use of CCB associated with decreased risk of failure to convert to SR. In Cox proportional model, female sex, age <63 years and CAD were associated with increased AF readmission within 1 year.
Dyslipidemia and LVEF <40% were associated with failure to cardiovert after first dose, and female sex and LVEF 40% were related to failure to convert at all on dofetilide in persistent AF patients. After 1-year follow-up, female sex, known CAD, and age <63 years were associated with increased AF readmissions.
多非利特是一种III类抗心律失常药物，用于将持续性心房颤动（AF）转复为窦性心律（SR）。
确定接受多非利特治疗的持续性AF患者转复和再次入院的临床预测因素。
我们分析了160例开始使用多非利特并随访1年的持续性AF患者。我们在多变量逻辑回归模型中检查了年龄、性别、种族、高血压、糖尿病、吸烟、血脂异常、冠心病、左心室射血分数（LVEF）、肌酐、体重指数以及钙通道阻滞剂（CCB）、β受体阻滞剂的联合使用情况。我们还在Cox回归模型中检查了这些预测因素与随访1年内AF相关再次入院的关系。
13.5%的个体使用多非利特后未转复为SR。55.6%在首剂时转复，83.1%在第四剂时转复。在多变量逻辑模型中，血脂异常（比值比：2.4，可信区间：1.12 - 5.16）和LVEF（比值比：3.83，可信区间：1.37 - 10.8）与首剂转复失败相关。女性和LVEF也与总体转复失败风险增加相关。CCB的联合使用与转复为SR失败风险降低相关。在Cox比例模型中，女性、年龄<63岁和冠心病与1年内AF再次入院风险增加相关。
血脂异常和LVEF<40%与首剂后转复失败相关，女性和LVEF 40%与持续性AF患者使用多非利特后总体转复失败相关。随访1年后，女性、已知冠心病和年龄<63岁与AF再次入院风险增加相关。
