Efficacy and safety of dofetilide in patients with atrial fibrillation and atrial flutter

Abstract

Dofetilide is more effective in patients with persistent than in those with paroxysmal AF/AFL. Importantly, short-term response does not necessarily predict long-term efficacy. Significant proarrhythmia can occur even with careful in-hospital monitoring.

Acute conversion of persistent atrial fibrillation during dofetilide loading does not predict long-term atrial fibrillation-free survival

“…This observation is consistent with the findings of Banchs and colleagues in a smaller, single center study [9]. One potential explanation for this finding is different mechanisms for maintenance and initiation of atrial arrhythmias, with dofetilide affecting maintenance more than initiation [27].…”

“…Overall, the high rate of pharmacologic conversion observed with dofetilide in our study increases its desirability in the treatment of persistent AF/AFl as pharmacologic conversion obviates the risks associated with anesthesia and direct current cardioversion. kConsistent with previous studies [7,9,11], we found long-term atrial arrhythmia suppression with dofetilide to be modest, with approximately one third of patients remaining arrhythmia free at 1 year. This degree of arrhythmia suppression is comparable to that observed with sotalol [6], flecainide [23], propafenone [24], and dronedarone [25] in long-term follow-up.…”

“…Previous studies of dofetilide in patients with persistent AF/AFl have reported large variations in rates of response [7][8][9]. In addition, initiation of dofetilide has been associated with a relatively high rate of acute pharmacologic conversion to sinus rhythm [10,11].…”

Antiarrhythmic Medications for Cardioversion and Maintenance of Sinus Rhythm in Patients with Cardiac Arrhythmias: A Review of the Literature

“…Rates of successful CCV with dofetilide have been reported to range from 29%-77% [88,[92][93][94][95], and typically takes ~2 ± 1 doses for conversion [92,93,95], with 21% of patients converting after the first dose of the drug [92]. Multiple studies have noted the rate of chemical cardioversion (CCV) to increase in a dose-dependent manner, the SAFIRE-D trial noted rates of 29.9% for 500 mcg BID, 9.8% for 250 mcg BID and 6.1% for 125 mcg BID [88,93].…”

“…Multiple studies have noted the rate of chemical cardioversion (CCV) to increase in a dose-dependent manner, the SAFIRE-D trial noted rates of 29.9% for 500 mcg BID, 9.8% for 250 mcg BID and 6.1% for 125 mcg BID [88,93]. Dofetilide has been noted to be more effective for CCV in AFL than AF with reported comparisons of 65% vs. 25% [95], and 75% vs. 22% [96].…”