Chen Chris, Lal Mallika, Burton Yunwoo, Chen Hongya, Stecker Eric, Masri Ahmad, Nazer Babak
Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA.
UW Medicine Heart Institute, University of Washington, Seattle, WA, USA.
Commun Med (Lond). 2023 Jul 19;3(1):99. doi: 10.1038/s43856-023-00315-8.
Professional society practice guidelines conflict regarding their recommendations of dofetilide (DOF) and sotalol (STL) for treatment of arrhythmias in hypertrophic cardiomyopathy (HCM), and supporting data is sparse. We aim to assess safety and efficacy of DOF and STL on arrhythmias in HCM.
This was an observational study of HCM patients treated with DOF or STL for atrial fibrillation (AF) and ventricular arrhythmias (VA). Outcomes of drug discontinuation and arrhythmia recurrence were compared at 1 year and latest follow-up by Kaplan-Meier analysis. Predictors of drug failure were studied using uni- and multi-variable analyses. Drug-related adverse events were quantitated.
Here we show that of our cohort of 72 patients (54 ± 14 years old, 75% male), 21 were prescribed DOF for AF, 52 STL for AF, and 18 STL for VA. At 1 year, discontinuation and recurrence rates were similar for DOF-AF (38% and 43%) and STL-AF (29% and 44%) groups. Efficacy data was similar at long-term follow-up of 1603 (IQR 994-4131) days, and for STL-VA. Drug inefficacy was the most common reason for discontinuation (28%) followed by side-effects (13%). Incidences of heart failure hospitalization (5%) and mortality (3%) were low. One STL-AF patient developed non-sustained torsades de pointes in the setting of severe pneumonia and acute kidney injury, but there were no other drug-related serious adverse events.
DOF and STL demonstrate modest efficacy and satisfactory safety when used for AF and VA in HCM patients.
专业学会的实践指南在多非利特（DOF）和索他洛尔（STL）用于治疗肥厚型心肌病（HCM）心律失常的推荐方面存在冲突，且支持数据稀少。我们旨在评估DOF和STL对HCM心律失常的安全性和有效性。
这是一项对接受DOF或STL治疗心房颤动（AF）和室性心律失常（VA）的HCM患者的观察性研究。通过Kaplan-Meier分析比较1年时和最新随访时停药和心律失常复发的结局。使用单变量和多变量分析研究药物治疗失败的预测因素。对药物相关不良事件进行量化。
我们在此表明，在我们的72例患者队列中（年龄54±14岁，75%为男性），21例因AF被处方DOF，52例因AF被处方STL，18例因VA被处方STL。1年时，DOF-AF组（38%和43%）和STL-AF组（29%和44%）的停药率和复发率相似。在1603天（四分位间距994 - 4131天）的长期随访中，DOF-AF组和STL-VA组的疗效数据相似。药物无效是停药的最常见原因（28%），其次是副作用（13%）。心力衰竭住院率（5%）和死亡率（3%）较低。1例STL-AF患者在严重肺炎和急性肾损伤的情况下发生了非持续性尖端扭转型室速，但没有其他与药物相关的严重不良事件。
DOF和STL用于HCM患者的AF和VA时显示出适度疗效和令人满意的安全性。
