Abstract |
The purpose of this study was to identify risk factors of Torsade de pointes (TdP) ventricular tachycardia in patients medicated with a class III antiarrhythmic drug ( dofetilide) and left ventricular systolic dysfunction with heart failure (HF) or recent myocardial infarction (MI). The 2 Danish Investigations of Arrhythmia and Mortality on Dofetilide ( DIAMOND) studies enrolled patients with HF ( DIAMOND-HF) or MI ( DIAMOND-MI) and left ventricular systolic dysfunction. The present analysis includes only patients treated solely with dofetilide. The incidence of TdP was 2.1% (32 of 1,511). Twenty-five of the incidences occurred in the DIAMOND-HF study and 7 cases in the DIAMOND-MI study (p = 0.0015). TdP was more frequent in women than in men (47% vs 28%, p = 0.02). Risk factors for developing TdP were female gender (odds ratio 2.2, 95% confidence interval [CI] 1.0 to 5.0), MI within 8 weeks (odds ratio 0.3, 95% CI 0.1 to 0.7), being in New York Heart Association class III or IV (odds ratio 3.2, 95% CI 1.2 to 8.6), and baseline QTc duration (odds ratio 1.14, 95% CI 1.00 to 1.30) per 10 ms. Women with chronic HF, QTc duration >400 ms. and New York Heart Association class III or IV had a risk of TdP of 10%, whereas no TdP episodes were observed in patients with QTc duration <400 ms. In conclusion, severity of HF, female gender, and QTc duration make it possible to identify patients with a high risk of early TdP when treated with dofetilide. Patients with recent MI less often had TdP compared with patients with chronic HF.
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Authors | Henriette Sloth Pedersen, Hanne Elming, Marie Seibaek, Hans Burchardt, Bente Brendorp, Christian Torp-Pedersen, Lars Køber, DIAMOND Study Group |
Journal | The American journal of cardiology
(Am J Cardiol)
Vol. 100
Issue 5
Pg. 876-80
(Sep 01 2007)
ISSN: 0002-9149 [Print] United States |
PMID | 17719337
(Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)
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Chemical References |
- Anti-Arrhythmia Agents
- Phenethylamines
- Placebos
- Potassium Channel Blockers
- Sulfonamides
- dofetilide
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Topics |
- Aged
- Aged, 80 and over
- Anti-Arrhythmia Agents
(therapeutic use)
- Atrial Fibrillation
(complications)
- Cardiac Output, Low
(complications)
- Cause of Death
- Double-Blind Method
- Electrocardiography
- Female
- Forecasting
- Heart Arrest
(etiology)
- Humans
- Male
- Middle Aged
- Myocardial Infarction
(complications)
- Phenethylamines
(therapeutic use)
- Placebos
- Potassium Channel Blockers
(therapeutic use)
- Risk Factors
- Sex Factors
- Sulfonamides
(therapeutic use)
- Time Factors
- Torsades de Pointes
(etiology)
- Ventricular Dysfunction, Left
(drug therapy)
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