PMID- 25626340
OWN - NLM
STAT- MEDLINE
DCOM- 20160314
LR  - 20220408
IS  - 1540-8159 (Electronic)
IS  - 0147-8389 (Linking)
VI  - 38
IP  - 4
DP  - 2015 Apr
TI  - Risk prediction for adverse events during initiation of sotalol and dofetilide 
      for the treatment of atrial fibrillation.
PG  - 490-8
LID - 10.1111/pace.12586 [doi]
AB  - BACKGROUND: Inpatient antiarrhythmic drug initiation for atrial fibrillation is 
      mandated for dofetilide (DF) and is often performed for sotalol (SL), 
      particularly if proarrhythmia risk factors are present. Whether low-risk patients 
      can be identified to safely allow outpatient initiation is unknown. METHODS: A 
      single-center retrospective cohort study was performed on patients initiated with 
      DF or SL. Risk factors for adverse events (AEs), defined as any arrhythmia or 
      electrocardiogram change requiring dose reduction or cessation, were identified. 
      RESULTS: Of 329 patients, 227 (69%) received SL and 102 (31%) DF. The cohort had 
      a mean age of 63 +/- 13 years; 70% of patients were male and had a baseline QTc of 
      440 +/- 37 ms. A total of 105 AEs occurred in 92 patients: QTc prolongation or 
      ventricular tachyarrhythmia in 70 patients (67% of AEs), bradyarrhythmias in 35 
      patients (33% of AEs), with some experiencing both AE types. Ventricular 
      arrhythmias were seen in 23 patients (7%) and torsades de pointes in one (0.3%). 
      Total AE rates were similar between drugs (P = 0.09); however, DF patients had 
      more QTc prolongation or ventricular arrhythmias (P = 0.001). In SL patients, 
      there were no predictors for QTc prolongation or ventricular proarrhythmia. In DF 
      patients, higher baseline QTc interval (odds ratio = 1.64/25 ms, P = 0.01) was an 
      independent predictor of QTc prolongation or ventricular proarrhythmias. For 
      patients without proarrhythmia risk factors, overall AE rate was 26%. 
      CONCLUSIONS: In conclusion, AEs are common during DF and SL initiation but rarely 
      severe in hospitalized inpatients. Baseline QTc predicts AEs for DF patients only 
      and AE are common even in "low-risk" patients. These results support in-hospital 
      drug initiation for all DF and SL patients.
CI  - (c) 2015 Wiley Periodicals, Inc.
FAU - Agusala, Kartik
AU  - Agusala K
AD  - From Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
FAU - Oesterle, Adam
AU  - Oesterle A
FAU - Kulkarni, Chiraag
AU  - Kulkarni C
FAU - Caprio, Timothy
AU  - Caprio T
FAU - Subacius, Haris
AU  - Subacius H
FAU - Passman, Rod
AU  - Passman R
LA  - eng
PT  - Journal Article
DEP - 20150128
PL  - United States
TA  - Pacing Clin Electrophysiol
JT  - Pacing and clinical electrophysiology : PACE
JID - 7803944
RN  - 0 (Anti-Arrhythmia Agents)
RN  - 0 (Phenethylamines)
RN  - 0 (Sulfonamides)
RN  - A6D97U294I (Sotalol)
RN  - R4Z9X1N2ND (dofetilide)
SB  - IM
MH  - Anti-Arrhythmia Agents/therapeutic use
MH  - Atrial Fibrillation/diagnosis/*drug therapy/*epidemiology
MH  - Comorbidity
MH  - Drug-Related Side Effects and Adverse Reactions/epidemiology/etiology
MH  - Female
MH  - Humans
MH  - Illinois/epidemiology
MH  - Long QT Syndrome/chemically induced/*epidemiology
MH  - Male
MH  - Middle Aged
MH  - Phenethylamines/adverse effects/*therapeutic use
MH  - Prevalence
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Sotalol/adverse effects/*therapeutic use
MH  - Sulfonamides/adverse effects/*therapeutic use
MH  - Treatment Outcome
MH  - Ventricular Fibrillation/chemically induced/*epidemiology
OTO - NOTNLM
OT  - antiarrhythmic drugs
OT  - atrial fibrillation
OT  - dofetilide
OT  - sotalol
EDAT- 2015/01/30 06:00
MHDA- 2016/03/15 06:00
CRDT- 2015/01/29 06:00
PHST- 2014/08/07 00:00 [received]
PHST- 2014/11/24 00:00 [revised]
PHST- 2014/12/21 00:00 [accepted]
PHST- 2015/01/29 06:00 [entrez]
PHST- 2015/01/30 06:00 [pubmed]
PHST- 2016/03/15 06:00 [medline]
AID - 10.1111/pace.12586 [doi]
PST - ppublish
SO  - Pacing Clin Electrophysiol. 2015 Apr;38(4):490-8. doi: 10.1111/pace.12586. Epub 
      2015 Jan 28.