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Dofetilide induced torsade de pointes: mechanism, risk factors and management strategies

Abhishek Jaiswal1, Seth Goldbarg1

  • 1Division of Cardiology, New York Hospital Queens/Weill Medical College of Cornell University, Flushing, NY 11355, USA.

Indian Heart Journal
|January 31, 2015
PubMed

Insights

Dofetilide effectively treats atrial fibrillation but carries a risk of proarrhythmia. Strict adherence to dosing guidelines minimizes the risk of torsades de pointes (Tdp) when using this antiarrhythmic drug.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Dofetilide is an effective antiarrhythmic medication for atrial fibrillation and flutter.
  • Proarrhythmia, including torsades de pointes (Tdp), is a known adverse effect of dofetilide.
  • Risk of Tdp is minimized with strict dosing based on renal function, QT interval, and drug interactions.

Purpose of the Study:

  • To review the mechanism, risk factors, and prevention of dofetilide-induced QT prolongation and Tdp.
  • To outline a management strategy for QT prolongation, ventricular arrhythmia, and Tdp.

Main Methods:

  • Literature review of dofetilide's antiarrhythmic properties and adverse effects.
  • Analysis of risk factors contributing to QT prolongation and Tdp.
  • Development of a clinical management scheme.

Main Results:

  • Dofetilide efficacy in rhythm conversion and maintenance is established.
  • Proarrhythmia risk is significantly reduced by individualized dosing and monitoring.
  • Clear guidelines for managing adverse events are crucial.

Conclusions:

  • Dofetilide offers significant benefits for selected patients with atrial arrhythmias.
  • Careful patient selection and adherence to dosing protocols are paramount to safety.
  • A structured approach to managing QT prolongation and Tdp enhances patient outcomes.
Keywords:
Atrial fibrillationDofetilideProarrhythmiaQT prolongationTorsade de Pointes

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