Abstract 16321: The Impact of Dofetilide on Early Recurrent Atrial Arrhythmia Post-Atrial Fibrillation Ablation During Hospitalization
Introduction: Management of early recurrence of atrial fibrillation (AF) or atrial flutter or atrial tachycardia (ERAF) post AF ablation patients is often very difficult. The aim of this study was to evaluate the outcome with dofetilide therapy in these refractory patients with ERAF after AF ablation.
Methods: We reviewed 2272 patients presenting for ablation between Nov 2000 and Dec 2011. Prospectively collected data from 41 consecutive patients (65±9 years, 31 male), in whom dofetilide for ERAF post-AF ablation was used during hospitalization, was analyzed.
Results: The baseline AF type was paroxysmal AF in 11 patients and persistent AF in 30 patients. Mean LVEF was 57±11%, mean LA volume index was 46±16 cc/m2. In addition to pulmonary vein isolation, 30 of 41 patients underwent additional ancillary linear or CFAE-related ablation. After ablation, the recurrent atrial arrhythmia was AF in 29 patients and atrial tachycardia in 12 patients. Dofetilide was initiated at doses of 250 mcg BID (n = 25) and of 500 mcg BID (n = 16). After a mean of 2.7 ± 2.7 doses of dofetilide, 33 of 41 (80%) patients converted to sinus rhythm (SR). Immediate response to dofetilide with termination of the arrhythmia was seen after one dose in 14 patients, after two doses in 6 patients, after three doses in 5 patients, after four doses in 4 patients, five or more doses in 3 patients, dose unknown in 1 patient. Each of these showed control of the arrhythmia by the time of discharge. Eight of 41 (20%) patients showed continuing ongoing atrial arrhythmia despite dofetilide administration. Five patients underwent successful DC cardioversion while 3 patients remained in AF at time of discharge. Thus, 38 of 41 (93%) patients were successfully converted from ERAF to SR at time of discharge. QTc interval of post-conversion to SR was significantly longer than that in baseline ECG (from 448±29 to 466±38 ms, p < 0.001). However, no patient experienced proarrhythmic events or had to discontinue dofetilide therapy.
Conclusion: Dofetilide is highly effective in post-AF ablation patients with ERAF. These data indicate the utility and safety of dofetilide therapy in terminating and controlling ERAF as temporary therapy after ablation.
Author Disclosures: M. Takami: None. K.H. Monahan: None. T.M. Munger: None. P.A. Friedman: None. S.J. Asirvatham: None. Y. Cha: None. P.A. Brady: None. B.D. Powell: None. D.L. Packer: Research Grant; Modest; Endosense, Siemens Acuson, EP Advocate, U of Minnesota Partnership for Biotechnology and Medical Genomics, CardioFocus, Hansen Medical, Thermedical. Consultant/Advisory Board; Modest; Abiomed $0, Biosense Webster $0, Boston Scientific $0, CardioDX $0, CardioFocus $0, CardioInsight $0, InfoBionics $0, Johnson & Johnson $0, Medtronic/CryoCath $0, Sanofi-Aventis $0, Siemens $0, St. Jude Medical $0, OrthoMcNeill $0. Other; Modest; Royalty Blackwell Publishing, Oxford Publishing, Oxford Royalty. Research Grant; Significant; Biosense Webster, EpiEP, Medtronic, NIH, AHA Fellow Grant, Boston Scientific, St. Jude Medical. Other; Significant; Royalty St. Jude Medical.
- © 2014 by American Heart Association, Inc.