Abstract 15546: Use of Dofetilide for Atrial Arrhythmias in the Adult Patient With Congenital Heart Disease
Background: The treatment of atrial arrhythmias in the adult congenital population has been challenging. Long-term side effects of class III anti-arrhythmics have limited their utility. Catheter ablation in this subset of patients is technically challenging with poor long-term success.
Objective: The purpose of the study was to examine the efficacy and side effect profile of dofetilide in the treatment of atrial arrhythmias in the adult congenital patient.
Methods: A retrospective chart review was performed at a single institution.
Results: Between 2008 and 2013, dofetilide was administered to 2148 inpatients at the Cleveland Clinic. Twenty-five (1.2%) of these patients had congenital heart disease and of these, 18 patients (mean age 47 years) received dofetilide as an initial load. Pre and post loading QTc intervals were 452±36ms and 502±22ms respectively (p-value <0.0001). Three (17%) had adverse events during inpatient initiation prompting discontinuation of therapy (one with torsade de pointes, one with sinus node dysfunction, one with excessive QTc prolongation). Two of the remaining 15 patients discontinued therapy prior to discharge secondary to arrhythmia persistence. Of the thirteen patients discharged on dofetilide, 4 discontinued therapy as an outpatient (waning effect n=3, anxiety n=1) after an average follow-up of 304 days (range 7-966 days). The remaining 9 patients (50%) continue on therapy with resolution or improvement of atrial arrhythmias with a mean follow-up of 618 days (range 50-1577 days) with no adverse events.
Conclusion: With standard precautions, dofetilide can be a useful and safe antiarrhythmic therapy in adult congenital patients with atrial arrhythmias.
- © 2013 by American Heart Association, Inc.