Document Detail


Qtc interval as a guide to select those patients with congestive heart failure and reduced left ventricular systolic function who will benefit from antiarrhythmic treatment with dofetilide.
MedLine Citation:
PMID:  11245647     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: A prolonged QTc interval is considered a contraindication for class III antiarrhythmic drugs, but the influence of a normal or a slightly increased baseline QTc interval on the risk or benefit of treatment with a class III antiarrhythmic drug is not sufficiently clarified. METHODS AND RESULTS: This prospectively defined substudy included 703 patients enrolled in the Danish Investigations of Arrhythmia and Mortality on Dofetilide-Congestive Heart Failure (DIAMOND-CHF) study. Patients included had moderate to severe CHF and reduced left ventricular systolic function. Baseline QTc interval was measured before randomization to either dofetilide, a new class III antiarrhythmic drug, or placebo. During a median follow-up of 18 months (minimum 1 year), 285 patients (41%) died. Baseline QTc interval had no prognostic value on survival in placebo-treated patients. In dofetilide-treated patients, a baseline QTc interval <429 ms was associated with a significant risk reduction (risk ratio 0.4, 95% CI 0.3 to 0.8). With increasing QTc interval, the risk increased gradually, and for QTc interval >479 ms, risk ratio was 1.3 (0.8 to 1.9). CONCLUSIONS: A baseline QTc interval within normal limits is associated with a marked reduction of mortality in patients with CHF and left ventricular systolic dysfunction treated with dofetilide. This is a potentially important indication of which patients with CHF might benefit from prophylactic treatment with an antiarrhythmic drug.
Authors:
B Brendorp; H Elming; L Jun; L Køber; M Malik; G B Jensen; C Torp-Pedersen;
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Circulation     Volume:  103     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2001 Mar 
Date Detail:
Created Date:  2001-03-14     Completed Date:  2001-05-24     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1422-7     Citation Subset:  IM    
Affiliation:
Copenhagen University Hospital, Gentofte, Denmark.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Anti-Arrhythmia Agents / therapeutic use*
Double-Blind Method
Female
Heart Failure / drug therapy*,  mortality,  physiopathology
Humans
Long QT Syndrome / etiology*
Male
Middle Aged
Multivariate Analysis
Patient Selection
Phenethylamines / therapeutic use*
Prospective Studies
Sulfonamides / therapeutic use*
Survival Analysis
Treatment Outcome
Ventricular Function, Left
Chemical
Reg. No./Substance:
0/Anti-Arrhythmia Agents; 0/Phenethylamines; 0/Sulfonamides; 115256-11-6/dofetilide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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