Practice variation in the re-initiation of dofetilide: An observational study

Turagam, Mohit K.; Afzal, Muhammad R.; Reddy, Madhu; Pillarisetti, Jayasree; Lavu, Madhav; Atkins, Donita; Jeffrey, Courtney; Christensen, Katie; Pimentel, Rhea; Dendi, Raghuveer; Vacek, James L.; Hurwitz, Jodi; Biase, Luigi Di; Lakkireddy, Dhanunjaya

doi:10.1016/j.ijcard.2017.01.157

Cited by 6 publications

(3 citation statements)

References 21 publications

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“…Wide variation in practice was seen with 21% of cardiologists always admitting patients for reinitiation of dofetilide, while 37% of physicians admitted pateints in <10% of cases. 29 In 2017, a retrospective study from Cleveland Clinic analyzed 138 patients admitted for reinitiation of dofetilide from 2008 to 2012. No TdP occurred in patients reloaded at their previous dofetilide dose, but 6.7% of patients reloaded at a higher than previous dose did experience TdP.…”

Section: Dofetilide Reloadingmentioning

confidence: 99%

A Quarter of a Century Later: What is Dofetilide’s Clinical Role Today?

Wolbrette

Hussain

Maraj

et al. 2018

J Cardiovasc Pharmacol Ther

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Dofetilide is a class III antiarrhythmic agent approved by the Food and Drug Administration for the conversion of atrial fibrillation and atrial flutter and maintenance of sinus rhythm in symptomatic patients with persistent arrhythmia. Drug trials showed neutral mortality in post-myocardial infarction patients and those with heart failure. This is a review of postmarket data, including real-world efficacy and safety in a variety of populations. Dofetilide has been used off-label with success in patients with paroxysmal atrial fibrillation and atrial flutter, as well as atrial tachycardia and ventricular tachycardia. The real-world acute conversion rate of atrial fibrillation and atrial flutter is higher than that reported in clinical trials. Dofetilide has an acceptable safety profile when initiated (or reloaded) under hospital monitoring and dosed according to creatinine clearance. Dofetilide is well tolerated and a good choice for patients with acceptable renal function and a normal QT interval, especially if atrioventricular nodal blockade needs to be avoided.

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Section: Dofetilide Reloadingmentioning

confidence: 99%

A Quarter of a Century Later: What is Dofetilide’s Clinical Role Today?

Wolbrette

Hussain

Maraj

et al. 2018

J Cardiovasc Pharmacol Ther

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“…Dofetilide has been also reported to be safe and effective when rapidly switched from amiodarone and also when administered for "re-initiation" as an outpatient [11,12]. The results of a well-conducted survey in the real-world clinical settings of 347 practicing cardiologists, the majority of whom were electrophysiologists, regarding their practice preferences concerning initiation and re-initiation of dofetilide were quite interesting; (i) 78% expressed that dofetilide re-initiation can be done on outpatient basis in the presence of normal serum (iii) 70% of the physicians reported no major adverse events;…”

Section: Major Findingsmentioning

confidence: 99%

“…(iv) only 32% reported checking serum potassium, magnesium, and creatinine clearance; and (v) only 17% of the physicians checked QT interval at 48 h after the first dose of dofetilide during re-initiation [12]. The ability to discern QTc prolongation on CIED investigation is another favorable reason in terms of initiating dofetilide on an outpatient basis.…”

Section: Major Findingsmentioning

confidence: 99%

Outpatient initiation of dofetilide: insights from the complexities of atrial fibrillation management during the COVID-19 lockdown

Mascarenhas

Mudumbi

Kantharia

2021

J Interv Card Electrophysiol

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Background At peak COVID-19 lockdown, patients with symptomatic atrial fibrillation (AF) were faced with an equipoise between a palliative rate-control versus cautious rhythm-control strategy, including hospitalization for initiation of antiarrhythmic drug/s (AADs) and cardiac procedures which was impossible due to hospitalization restrictions. Objectives We aimed to evaluate the efficacy and safety of outpatient initiation of dofetilide in patients with AF using cardiac implantable electronic devices (CIEDs) for rhythm and QTc interval monitoring. Methods Adult patients with symptomatic AF with prior failure or intolerance to other AADs were enrolled if they were willing to in-office insertion of implantable loop recorders or already implanted with pacemakers or defibrillators capable of remote monitoring. Exclusion criteria were known medical contraindications of dofetilide and unable to provide consent. After making a shared management decision, dofetilide was initiated in a physician office, and rhythm and QTc intervals were monitored by ECGs and CIEDs. Patients were followed to assess the efficacy and safety of the treatment. Results The study cohort comprised of 30 patients, age 76 ± 7 years (mean ± standard deviation), 10 female (33%), CHA 2 DS 2 -VASc score 3.25 ± 1.3, ejection fraction 63.45% ± 8.52, and QTc interval 431.68 ± 45.09 ms. From 22 (73%) patients in AF at presentation, SR was restored in 14 (64%) patients after 4 doses of dofetilide. At 46 ± 59 days of follow-up, maintenance of SR in total 22 (73%) patients without cardiac adverse effects was accomplished. Conclusion Effective and safe outpatient initiation of dofetilide during the extenuating circumstance of COVID-19 lockdown was possible in patients with AF who had CIEDs.

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