Kansas City Heart Rhythm Institute & Research Foundation, Overland Park, Kansas.
Icahn School of Medicine at Mount Sinai, New York, New York.
Heart Rhythm. 2019 Jul;16(7):990-995. doi: 10.1016/j.hrthm.2019.01.028. Epub 2019 Jan 30.
Dofetilide is a class III antiarrhythmic drug commonly used for treatment of atrial fibrillation. Drug guidelines mandate a 3-month waiting period before initiating dofetilide after amiodarone use. Whether patients with an implantable cardioverter-defibrillator (ICD) can be rapidly switched from amiodarone to dofetilide is not known.
The purpose of this study was to evaluate whether rapid switching from amiodarone to dofetilide is safe in atrial fibrillation patients with an ICD.
In this retrospective observational study, we assessed the feasibility and the short- and long-term safety of rapid switching from amiodarone to dofetilide in hospitalized atrial fibrillation with an ICD.
The study included a total of 179 patients who were followed for 12.6 ± 2.2 months. All patients had drug initiation during hospitalization. Dofetilide resulted in successful cardioversion in 66% (118/179). Twenty percent of patients (36/179) required dofetilide dose adjustments in the initiation phase because of QT prolongation and decreased creatinine clearance. A total of 6.1% of patients (11/179) required drug discontinuation. The incidence of torsades de pointes was 1.1% (2/179) during initiation. One patient (0.5%) had self-terminating ventricular tachycardia at follow-up. No other significant adverse events were noted during follow-up.
Atrial fibrillation patients with an ICD can be rapidly switched to dofetilide after 7 days of discontinuation of amiodarone without significant arrhythmia-related complications. Prospective studies with large sample sizes, especially of women, should be performed to further validate these findings.
多非利特是一种常用于治疗心房颤动的 III 类抗心律失常药物。药物指南规定，在开始使用多非利特之前，需要在停用胺碘酮后等待 3 个月。目前尚不清楚是否可以将植入式心脏复律除颤器（ICD）患者迅速从胺碘酮切换到多非利特。
本研究旨在评估在患有 ICD 的心房颤动患者中，是否可以安全地将胺碘酮迅速转换为多非利特。
在这项回顾性观察性研究中，我们评估了在患有 ICD 的住院心房颤动患者中，迅速将胺碘酮转换为多非利特的可行性以及短期和长期安全性。
该研究共纳入 179 例患者，随访时间为 12.6±2.2 个月。所有患者均在住院期间开始用药。多非利特使 66%（118/179）的患者成功转复为窦性心律。由于 QT 延长和肌酐清除率降低，20%（36/179）的患者在起始阶段需要调整多非利特剂量。共有 6.1%（11/179）的患者需要停药。起始时发生尖端扭转型室性心动过速的发生率为 1.1%（2/179）。1 例患者（0.5%）在随访期间出现自行终止的室性心动过速。随访期间未发生其他重大不良事件。
在停用胺碘酮 7 天后，ICD 患者可以迅速转换为多非利特，而不会出现明显的心律失常相关并发症。应进行具有较大样本量、特别是女性样本量的前瞻性研究，以进一步验证这些发现。
