Clinical Efficacy of Dofetilide for the Treatment of Atrial Tachyarrhythmias in Adults with Congenital Heart Disease

Banchs, Javier E.; Baquero, Giselle A.; Nickolaus, Michelle J.; Wolbrette, Deborah L.; Kelleman, John; Samii, Soraya; Grando-Ting, Jennifer; Penny-Peterson, Erica; Davidson, William R.; Young, Sallie K.; Naccarelli, Gerald V.; González, Mario D.

doi:10.1111/chd.12129

“…The success rate of AAD without DCCV for terminating atrial arrhythmia has been reported as 70% for sotalol and dofetilide in several case series. 12–14 The present study suggests that DCCV is comparable with and may be superior to AAD conversion rates reported for acute treatment of atrial arrhythmia.…”

Section: Discussionsupporting

confidence: 73%

Outcomes of Direct Current Cardioversion in Adults With Congenital Heart Disease

Egbe

¹

,

Asirvatham

²

,

Connolly

³

et al. 2017

The American Journal of Cardiology

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Few data exist on direct current cardioversion (DCCV) in adult patients with congenital heart disease (CHD). This is a retrospective case-control study of 279 adults with CHD and 279 adults without CHD (control group) who had elective DCCV for atrial arrhythmias at Mayo Clinic, 2001 to 2013. Control patients were matched by gender and arrhythmia type. The objective was to compare DCCV procedural failure (failure to terminate the presenting arrhythmia) and arrhythmia recurrence (AR). In the CHD group (mean age 55 – 20 years; men 166 [59%]), the most common diagnosis was Fontan palliation (61; 22%). Trans-esophageal echocardiography was performed before DCCV in 216 patients (77%); 162 (58%) had atrial flutter, and 117 (42%) had atrial fibrillation. Procedural failure and AR between the case and the control groups were more common in the CHD group (14% vs 7%, p = 0.01) and (83% vs 66% at 60 months, p = 0.001) respectively. There were no deaths or thromboembolic complications. The multivariable risk factors for procedural failure were Fontan palliation and spontaneous echocardiographic contrast; the risk factors for AR were Fontan palliation and atrial fibrillation. When patients with Fontan palliation were excluded from the analysis, the outcome of DCCV (failure and recurrence rates) was similar for the CHD and non-CHD groups despite the age difference between the cohorts. In conclusion, the present study showed that DCCV outcomes were similar for CHD and non-CHD patients, with the exception of patients with Fontan palliation.

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“…The success rate of AAD without DCCV for terminating atrial arrhythmia has been reported as 70% for sotalol and dofetilide in several case series. [12][13][14] The present study suggests that DCCV is comparable with and may be superior to AAD conversion rates reported for acute treatment of atrial arrhythmia.…”

Section: Discussionsupporting

confidence: 73%

Outcomes of Direct Current Cardioversion in Adults With Congenital Heart Disease

Egbe

¹

,

Asirvatham

²

,

Kapa

³

et al. 2017

Journal of the American College of Cardiology

0

View full text Add to dashboard Cite

Few data exist on direct current cardioversion (DCCV) in adult patients with congenital heart disease (CHD). This is a retrospective case-control study of 279 adults with CHD and 279 adults without CHD (control group) who had elective DCCV for atrial arrhythmias at Mayo Clinic, 2001 to 2013. Control patients were matched by gender and arrhythmia type. The objective was to compare DCCV procedural failure (failure to terminate the presenting arrhythmia) and arrhythmia recurrence (AR). In the CHD group (mean age 55 -20 years; men 166 [59%]), the most common diagnosis was Fontan palliation (61; 22%). Trans-esophageal echocardiography was performed before DCCV in 216 patients (77%); 162 (58%) had atrial flutter, and 117 (42%) had atrial fibrillation. Procedural failure and AR between the case and the control groups were more common in the CHD group (14% vs 7%, p = 0.01) and (83% vs 66% at 60 months, p = 0.001) respectively. There were no deaths or thromboembolic complications. The multivariable risk factors for procedural failure were Fontan palliation and spontaneous echocardiographic contrast; the risk factors for AR were Fontan palliation and atrial fibrillation. When patients with Fontan palliation were excluded from the analysis, the outcome of DCCV (failure and recurrence rates) was similar for the CHD and non-CHD groups despite the age difference between the cohorts. In conclusion, the present study showed that DCCV outcomes were similar for CHD and non-CHD patients, with the exception of patients with Fontan palliation.Atrial arrhythmia is common in adult patients with congenital heart disease (CHD), and the prevalence varies with lesion complexity and age of the patient. [1][2][3] It is associated with a higher risk of heart failure, ventricular dysfunction, and thromboembolic complications. [1][2][3][4] Restoration and maintenance of the sinus rhythm is therefore important to prevent these complications. 5 There are limited data on the outcomes of elective direct current cardioversion (DCCV) in adults with CHD. 6,7 A previous study 6 from our institution, involving a small cohort with limited follow-up, showed that DCCV is safe and effective in terminating atrial arrhythmia in this population. The present study involved a large cohort

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“…310 Atrial flutter can occur in clinical settings similar to those associated with AF, and atrial flutter can be triggered by AT or AF. 121,311 It is common for AF and atrial flutter to coexist in the same patient. After CTI ablation, 22% to 50% of patients have been reported to develop AF after a mean follow-up of 14 to 30 months, although 1 study reported a much higher rate of AF development, with 82% of patients treated by catheter ablation for atrial flutter manifesting AF within 5 years.…”

Section: Cavotricuspid Isthmus-dependent Atrial Fluttermentioning

confidence: 99%

2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia

Page¹,

Joglar²,

Caldwell³

et al. 2016

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Clinical Efficacy of Dofetilide for the Treatment of Atrial Tachyarrhythmias in Adults with Congenital Heart Disease

Abstract: D should be considered a pharmacologic alternative when adult patients with CHD develop AT. D does not depress conduction, sinus node, or ventricular function but needs close monitoring for potential ventricular pro-arrhythmia.

Cited by 24 publications

References 20 publications

Outcomes of Direct Current Cardioversion in Adults With Congenital Heart Disease

Outcomes of Direct Current Cardioversion in Adults With Congenital Heart Disease

Outcomes of Direct Current Cardioversion in Adults With Congenital Heart Disease

2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia

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