Abstract 20586: Comparison of Inpatient Initiation of Sotalol vs Dofetilide in Patients With Atrial Fibrillation
Introduction: There is limited data comparing the safety and efficacy of dofetilide and sotalol in the management of atrial fibrillation.
Hypothesis: Both dofetilide and sotalol have similar efficacy and risk profile in treating patients with AF, however the QT dynamics differ.
Methods: We performed retrospective study of 378 AF patients (129 persistent, 249 paroxysmal) who were admitted for dofetilide or sotalol (298 and 80 patients respectively) initiation between 2012 and 2015. Dofetilide was initiated with the manufacturers recommended protocol. EKG was obtained two hours after each dose of both the drugs for QTc evaluation. Dose of sotalol at discharge was 80, 120 and 160 mg twice daily in 21, 48 and 7 patients respectively. Dose of dofetilide at discharge was 500, 250 and 125 mcg twice daily in 149, 86 and 10 patients respectively.
Results: Baseline QTc was not different between the groups. However, dofetilide patients had significantly higher QTc after each of the doses when compared to those of sotalol; independent of the doses. 28 (7.4%) patients had drug discontinuation prior to discharge with 24; 8.8% vs 4; 5 %; p=0.47 in dofetilide and sotalol groups respectively. QTc prolongation after the 1st dose did not predict the likelihood of discontinuation of any of the two drugs. 215 (72%) patients in dofetilide group vs 48 (60%) in sotalol group were in AF on arrival of which 125 (58%) and 30 (63%) patients had successful chemical cardioversion respectively (p=0.578). 263 (88.2%) patients who received dofetilide vs 73(91%) patients on sotalol were on normal sinus rhythm at discharge (p=0.67). There was no significant difference in incidence of torsades between the groups; 1.3% vs 0% (p=0.58).
Conclusions: In our large, single center experience, we found that the use of dofetilide resulted in significantly higher QTc when compared to that of sotalol in AF patients. This did not translate to a difference in the success rate, tolerance, or adverse events.
Author Disclosures: V. Gunasekaran: None. S. Iskandar: None. M. Reddy: None. S. Bommana: None. D. Atkins: None. D. Lakkireddy: None.
- © 2016 by American Heart Association, Inc.