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(Circulation. 2001;104:292.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Efficacy of Dofetilide in the Treatment of Atrial Fibrillation-Flutter in Patients With Reduced Left Ventricular Function
A Danish Investigations of Arrhythmia and Mortality ON Dofetilide (DIAMOND) Substudy
From the Department of Cardiology (O.D.P., C.T.-P.), Gentofte University Hospital, and the Department of Medicine (L.K.), Rigshospitalet Heart Center, Copenhagen; the Department of Medicine (H.B.), Viborg Hospital, Viborg; Department of Medicine (N.K.), Esbjerg Hospital, Esbjerg, Denmark; and Pfizer Central Research (B.M.), Sandwich, UK.
Correspondence and reprint requests to Ole Dyg Pedersen, MD, Department of Cardiology, Gentofte University Hospital, Niels Andersensvej 65, 2900 Hellerup, Denmark. E-mail odplc{at}mail.dk
Background— In patients with left ventricular dysfunction, atrial fibrillation and flutter (AF and AFl, respectively) are common arrhythmias associated with increased morbidity and mortality. The present study investigated the potential of dofetilide in AF-AFl patients with left ventricular dysfunction to restore and maintain sinus rhythm, which might reduce mortality and hospitalizations.
Methods and Results— In the Danish Investigations of Arrhythmia and Mortality ON Dofetilide (DIAMOND) studies, 506 patients were in AF-AFl at baseline. Over the course of study, cardioversion occurred in 148 (59%) dofetilide- and 86 (34%) placebo-treated patients. In these patients, the probability of maintaining sinus rhythm for 1 year was 79% with dofetilide versus 42% with placebo (P<0.001). Dofetilide had no effect on all-cause mortality, but restoration and maintenance of sinus rhythm was associated with significant reduction in mortality (risk ratio [RR], 0.44; 95% CI, 0.30 to 0.64; P<0.0001). In addition, dofetilide therapy was associated with a significantly lower risk ratio versus placebo for either all-cause (RR, 0.70; 95% CI, 0.56 to 0.89; P
0.005) or congestive heart failure (RR, 0.69; 95% CI, 0.51 to 0.93; P0.02) rehospitalization.
Conclusions— Dofetilide is safe and increases the probability of obtaining and maintaining sinus rhythm in patients with structural heart disease. The present study suggests that restoration of sinus rhythm is associated with improved survival.
Key Words: antiarrhythmia agents • arrhythmia • heart failure • fibrillation • tachyarrhythmias
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