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

被引:58
作者
Brendorp, B
Elming, H
Jun, L
Kober, L
Malik, M
Jensen, GB
Torp-Pedersen, C
机构
[1] Copenhagen Univ Hosp, Gentofte, Denmark
[2] Copenhagen Univ Hosp, Hvidovre, Denmark
[3] Univ London St Georges Hosp, Sch Med, London SW17 0RE, England
关键词
heart failure; prognosis; antiarrhythmia agents;
D O I
10.1161/01.CIR.103.10.1422
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.
引用
收藏
页码:1422 / 1427
页数:6
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