Acute conversion of persistent atrial fibrillation during dofetilide initiation.

Acute conversion of persistent atrial fibrillation during dofetilide initiation. Research Abstract Details 

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Acute conversion of persistent atrial fibrillation during dofetilide initiation. Abstract Text:

Delia Cotiga,Aysha Arshad,Emad Aziz,Sandeep Joshi,Jayanthi N Koneru,Jonathan S Steinberg,Delia Cotiga,Aysha Arshad,Emad Aziz,Sandeep Joshi,Jayanthi N Koneru,Jonathan S Steinberg,

Background:Dofetilide (D) is a highly selective blocker of the rapid component of the delayed rectifier potassium current and was approved for the treatment of atrial fibrillation (AF) based on a satisfactory safety/efficacy profile from trials in patients with left ventricle (LV) dysfunction or heart failure. The dose-dependant acute conversion rates (<72 hours) were reported to be in the range of 6-30%. We hypothesized that the acute pharmacological conversion rate of D is higher than previously reported if used in a healthier cohort of patients with persistent AF. Methods and Results:Eighty consecutive patients received D dosing per Cockroft-Gault adjustment for creatinine clearance and QTc intervals. Patients were 61 +/- 10 years, 79% male, ejection fraction (EF) 53 +/- 13%, coronary artery disease 20%, and left atrial dimension 4.1 +/- 0.2 cms. The duration of the treated AF episode was a median of 19 days (range 10-113 days). All patients received D while on telemetry for at least six dosing intervals. After 2.2 +/- 1.2 doses, 77% of patients converted to sinus rhythm (SR) and 23% did not and required direct current (DC) cardioversion. Acute pharmacological conversion rates were: 20% for D 125 mcg bid, 44% for 250 mcg bid, and 85% for 500 mcg bid. None of the patients had torsade de pointes and none had to stop D for intolerance. Failure to convert to SR on D alone was associated with larger left atrium (LA) diameter (P = 0.04), longer duration of AF (P = 0.02), and use of lower dosages of D (P = 0.04). Conclusions:D had an unusually high pharmacological conversion rate, demonstrated an incremental dose response, and was well tolerated and safe, in a relatively healthy adult cohort with persistent AF. In addition to D dose, pharmaco-conversion was predicted by LA size and AF duration. D is a desirable alternative for conversion of AF in a variety of clinical settings.

Acute conversion of persistent atrial fibrillation during dofetilide initiation. Publishing Authors By Initials

D Cotiga,A Arshad,E Aziz,S Joshi,JN Koneru,JS Steinberg,D Cotiga,A Arshad,E Aziz,S Joshi,JN Koneru,JS Steinberg,

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Acute conversion of persistent atrial fibrillation during dofetilide initiation. Journal Published:

PUBLICATION TYPE: Journal Article

Journal: Pacing and clinical electrophysiology : PACE

VOLUME: 30

Page Numbers: 1527-30

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ISSN: 0147-8389

DAY: 11

MONTH: Dec

YEAR: 2007

Acute conversion of persistent atrial fibrillation during dofetilide initiation. Information

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LANGUAGE: eng

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AFFILIATION: Arrhythmia Service and Division of Cardiology, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians & Surgeons, New York, New York, USA.

Country: United States

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MEDLINETA: Pacing Clin Electrophysiol

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