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Dofetilide use is not associated with increased mortality in patients with left ventricular hypertrophy and atrial

Daniel G Wann¹, Brent S Medoff¹, Noor-Ul-Huda A Mehdi²

¹Center for Atrial Fibrillation, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.

Journal of Cardiovascular Electrophysiology

|November 6, 2022

Insights

Dofetilide did not increase mortality in patients with left ventricular hypertrophy (LVH) and atrial fibrillation (AF). This study suggests dofetilide may be a safe option for managing symptomatic AF in this patient group.

Area of Science:

Cardiology
Clinical Pharmacology
Electrophysiology

Background:

Left ventricular hypertrophy (LVH) is common in atrial fibrillation (AF) patients.
Antiarrhythmic drugs (AADs) are often contraindicated in LVH.
US guidelines advise against dofetilide in LVH due to safety concerns, despite limited clinical data.

Purpose of the Study:

To investigate the association between dofetilide use and mortality in patients with AF and LVH.
To evaluate the safety of dofetilide in a population where it is typically avoided.

Main Methods:

Propensity matching was used to compare patients with AF and LVH treated with dofetilide versus those not on AADs.
The study included 718 patients (359 per group) with LVH ≥1.4 cm.
Primary outcome was all-cause mortality at 3 years; secondary outcomes included hospitalizations.

Main Results:

Dofetilide use was not associated with increased all-cause mortality at 3 years (7% vs. 12% in control group; HR 0.90).
Total hospitalizations were higher in the control group.
Hospitalizations specifically for AF were similar between the dofetilide and control groups.

Conclusions:

Dofetilide use was not linked to increased mortality in a propensity-matched cohort of patients with AF and LVH.
Findings support the safety of dofetilide in this population, challenging current guideline recommendations.
Dofetilide may be a viable treatment option for symptomatic AF management in patients with LVH.

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Abstract

Background:

Left ventricular hypertrophy (LVH) is common in patients with atrial fibrillation (AF), however, many antiarrhythmic drugs (AADs) are contraindicated. US guidelines recommend avoiding pure class III antiarrhythmics such as dofetilide in patients with significant LVH due to concern for an increased risk of death, however, clinical data is lacking. We sought to determine if dofetilide use was associated with increased mortality in patients with LVH.

Methods:

Patients ≥18 years of age with AF and LVH ≥ 1.4 cm were included. A group of patients treated with dofetilide and a control group of patients without a history of AAD use were propensity matched. The primary outcome was all-cause mortality at 3 years and secondary outcomes were total number of all-cause hospitalizations and hospitalizations related to AF.

Results:

There were 359 patients in each of the groups. Baseline variables were well-matched. The primary outcome of all-cause mortality occurred in 7% of patients in the dofetilide group and 12% of patients in the control group (hazard ratio: 0.90, 95% confidence interval: 0.53-1.53). Total all-cause hospitalizations were higher in the control group but hospitalizations for AF were no different.

Conclusions:

In a propensity-matched cohort of 718 patients with AF and LVH, dofetilide was not associated with increased mortality at 3 years. Our study adds to prior data demonstrating the safety of dofetilide in this population despite guideline recommendations against its use. Given the limited options for AF management in LVH patients, dofetilide may be reasonable for symptomatic AF management.

Keywords:

Tikosyn antiarrhythmic atrial fibrillation class III dofetilide left ventricular hypertrophy

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