TY - JOUR
T1 - 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
AU - Brendorp, B
AU - Elming, H
AU - Jun, L
AU - Køber, L
AU - Malik, M
AU - Jensen, G B
AU - Torp-Pedersen, C
AU - DIAMOND Study Group
N1 - Keywords: Aged; Aged, 80 and over; Anti-Arrhythmia Agents; Double-Blind Method; Female; Heart Failure; Humans; Long QT Syndrome; Male; Middle Aged; Multivariate Analysis; Patient Selection; Phenethylamines; Prospective Studies; Sulfonamides; Survival Analysis; Treatment Outcome; Ventricular Function, Left
PY - 2001
Y1 - 2001
N2 - 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.
AB - 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.
M3 - Journal article
C2 - 11245647
SN - 0009-7322
VL - 103
SP - 1422
EP - 1427
JO - Circulation
JF - Circulation
IS - 10
ER -