■心房颤动是最常见的心律失常,出现有症状的患者生活质量下降和心力衰竭恶化。多非利特,3类抗心律失常药,是一种经过验证和安全的节律控制药物。QT延长导致尖端扭转性室性心动过速(TdP)的初始风险需要标准方案强制住院三天才能开始。
■评估坚持起始方案时的安全性,并确定选择性多非利特入院对TdP易感性的特征。
■我们进行了一项回顾性研究,涉及在2003年至2022年期间进入四个州的梅奥诊所的患者,这些患者因选择住院开始使用多非利特而入院。患者的图表接受了审查,关注与多非利特相关的TdP发生,基线特征,包括QT间期,实验室值,合并症,和伴随的药物。对经历TdP的患者进行进一步评估以确定潜在的危险因素。
■在确定的2036名患者中,平均年龄66.4±11.4岁,67.2%的男性,16例出现多非利特相关TdP(发生率0.79%)。值得注意的是,81%(13/16)的TdP病例发生在偏离FDA/制造商算法协议的患者中。同时使用主动静脉利尿剂治疗,地高辛,和QT延长药物成为可识别的危险因素。此外,女性TdP发生率(1.5%)高于男性(0.44%){奇数比[OR]3.46;P=0.017}。
■与多非利特起始相关的TdP的总发生率较低(0.79%)。在择期住院期间遵守协议似乎非常安全。不需要同时使用静脉利尿剂的患者,地高辛,或QT延长药物显示TdP的风险较低。
UNASSIGNED: Atrial fibrillation is the most prevalent cardiac arrhythmia, presenting symptomatic patients with diminished quality of life and worsening of heart failure. Dofetilide, a class 3 antiarrhythmic agent, is a proven and safe rhythm control medication. Initial risk of QT prolongation leading to torsade de pointes (TdP) necessitates a standard protocol mandating hospitalization for three days for initiation.
UNASSIGNED: To assess safety when adhering to initiation protocol and identify traits for susceptibility to TdP in elective dofetilide admissions.
UNASSIGNED: We conducted a retrospective study involving patients admitted to Mayo Clinic sites across four states for elective inpatient initiation of dofetilide between 2003 and 2022. Patients\' charts underwent review, focusing on dofetilide-related TdP occurrences, baseline characteristics including QT intervals, laboratory values, comorbidities, and concomitant medications. Patients who experienced TdP were subjected to further evaluation to identify potential risk factors.
UNASSIGNED: Of 2036 patients identified, mean age 66.4 ± 11.4 years, and 67.2 % male, 16 experienced dofetilide-related TdP (incidence rate 0.79%). Notably, 81% (13/16) of TdP cases occurred in patients who deviated from the FDA/manufacturer algorithm protocol. The concomitant use of active intravenous diuretic therapy, digoxin, and QT-prolonging drugs emerged as identifiable risk factors. Additionally, females exhibited a higher incidence of TdP (1.5%) than males (0.44%) {odd ratio [OR] 3.46; P = 0.017}.
UNASSIGNED: Overall incidence of TdP related to dofetilide initiation was low (0.79%). Adherence to protocol during elective hospital admissions appears extraordinarily safe. Patients who did not require concurrent use of intravenous diuretics, digoxin, or QT prolonging drugs exhibited lower risk of TdP.