Drexel University College of Medicine, Philadelphia, PA, USA.
Cardiovascular and Heart Rhythm Consultants, 30 West 60th Street, Suite 1U, New York, NY, 10023, USA.
J Interv Card Electrophysiol. 2022 Jan;63(1):21-28. doi: 10.1007/s10840-021-00942-y. Epub 2021 Jan 23.
At peak COVID-19 lockdown, patients with symptomatic atrial fibrillation (AF) were faced with an equipoise between a palliative rate-control versus cautious rhythm-control strategy, including hospitalization for initiation of antiarrhythmic drug/s (AADs) and cardiac procedures which was impossible due to hospitalization restrictions.
We aimed to evaluate the efficacy and safety of outpatient initiation of dofetilide in patients with AF using cardiac implantable electronic devices (CIEDs) for rhythm and QTc interval monitoring.
Adult patients with symptomatic AF with prior failure or intolerance to other AADs were enrolled if they were willing to in-office insertion of implantable loop recorders or already implanted with pacemakers or defibrillators capable of remote monitoring. Exclusion criteria were known medical contraindications of dofetilide and unable to provide consent. After making a shared management decision, dofetilide was initiated in a physician office, and rhythm and QTc intervals were monitored by ECGs and CIEDs. Patients were followed to assess the efficacy and safety of the treatment.
The study cohort comprised of 30 patients, age 76 ± 7 years (mean ± standard deviation), 10 female (33%), CHADS-VASc score 3.25 ± 1.3, ejection fraction 63.45% ± 8.52, and QTc interval 431.68 ± 45.09 ms. From 22 (73%) patients in AF at presentation, SR was restored in 14 (64%) patients after 4 doses of dofetilide. At 46 ± 59 days of follow-up, maintenance of SR in total 22 (73%) patients without cardiac adverse effects was accomplished.
Effective and safe outpatient initiation of dofetilide during the extenuating circumstance of COVID-19 lockdown was possible in patients with AF who had CIEDs.
在 COVID-19 封锁高峰期，有症状的心房颤动 (AF) 患者面临着姑息性的心率控制与谨慎的节律控制策略之间的平衡，包括因住院限制而无法进行抗心律失常药物/（AADs）和心脏程序的起始治疗。
我们旨在评估使用心脏植入式电子设备 (CIEDs) 进行心律和 QTc 间期监测，在门诊起始使用多非利特治疗 AF 的疗效和安全性。
如果愿意在门诊进行植入式环路记录器的插入或已经植入具有远程监测功能的起搏器或除颤器的情况下，有症状的 AF 且既往对其他 AADs 治疗失败或不耐受的成年患者将被纳入研究。排除标准为已知多非利特的医学禁忌证和无法提供同意书。在做出共同管理决策后，在医生办公室开始使用多非利特，通过心电图和 CIED 监测心律和 QTc 间期。随访患者以评估治疗的疗效和安全性。
研究队列包括 30 名患者，年龄 76 ± 7 岁（平均值 ± 标准差），10 名女性（33%），CHA2DS2-VASc 评分 3.25 ± 1.3，射血分数 63.45% ± 8.52%，和 QTc 间期 431.68 ± 45.09 ms。在就诊时存在 AF 的 22 名患者中（73%），14 名患者（64%）在使用多非利特 4 剂后恢复了窦性心律。在 46 ± 59 天的随访中，22 名患者（73%）总窦性心律维持，无心脏不良事件发生。
在 COVID-19 封锁的危急情况下，对于有 CIED 的 AF 患者，门诊起始使用多非利特是可行的，且有效和安全。
