© 2002 European Society of Cardiology
Effect of dofetilide on QT dispersion and the prognostic implications of changes in QT dispersion for patients with congestive heart failure
a Department of Cardiology Copenhagen University Hospital, Gentofte, Denmark
b Department of Cardiology Copenhagen University Hospital, Rigshospitalet, Denmark
* Corresponding author. Skippermosen 11, 3400 Hillerød, Denmark. Tel.: +45-482-68623; fax: +45397-51803. E-mail address: bb{at}heart.dk, he{at}heart.dk, jlimcdcn{at}mail.sc.cninfo.net, lk{at}heart.dk, ctp{at}heart.dk
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Abstract |
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Aims: Drug-induced changes in QT dispersion may be a way of detecting harmful repolarisation abnormalities for patients receiving antiarrhythmic drugs affecting ventricular repolarisation.
Methods and results: In 463 congestive heart failure (CHF) patients enrolled in the Danish Investigations Of Arrhythmia and Mortality On Dofetilide-CHF (DIAMOND-CHF) study, both pre-treatment and on-treatment day 2–6 QT dispersion was available from standard 12-lead ECGs. Patients were randomised in a double-blind manner to receive either placebo or dofetilide, a new class III antiarrhythmic drug. During a median follow-up of 19 months (minimum 1 year), 179 patients (39%) died (135 patients from cardiac causes). Changes in QT dispersion did not predict all-cause or cardiac mortality for patients treated with dofetilide in multivariate survival analysis (Risk ratio: 1.02, 95% confidence interval: 0.97–1.08, P>0.4). This finding was independent of pre-treatment QT dispersion. Dofetilide caused a small QT dispersion increment of 8 ms, not different from the changes seen in the placebo group (3 ms).
Conclusion: For patients with CHF and reduced left ventricular systolic function, changes in QT dispersion following treatment with dofetilide do not predict all-cause or cardiac mortality. The dofetilide-induced QT dispersion changes are small and comparable to those seen in placebo treated patients.
Key Words: QT dispersion • Heart failure • Prognosis • Arrhythmia • Antiarrhythmic agents
Received April 19, 2001; Revised June 21, 2001; Accepted September 7, 2001
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