Pause-dependent polymorphic ventricular tachycardia during long-term treatment with dofetilide: a placebo-controlled, implantable cardioverter-defibrillator-based evaluation.
Pause-dependent polymorphic ventricular tachycardia during long-term treatment with dofetilide: a placebo-controlled, implantable cardioverter-defibrillator-based evaluation.
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多非利特长期治疗期间的暂停依赖性多形性室性心动过速：安慰剂对照、基于植入式心脏复律除颤器的评估。
DOI：
10.1016/s0735-1097(01)01106-8
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发表时间：
2001
影响因子：
24
通讯作者：
Roden,DM
中科院分区：
文献类型：
--
作者：
Mazur,A;Anderson,ME;Bonney,S;Roden,DM
目的比较随机分配至QT延长抗心律失常药物多非利特或安慰剂组的植入式心律转复器（ICD）患者中暂停依赖性多形性室性心动过速（PVT）的发生率。背景药物相关性尖端扭转型室性心动过速（TdP）通常在开始治疗的几天内被识别，但它的发病率在很长一段时间内，方法我们在一项多中心研究中评估了TdP和ICD电图与TdP兼容的频率，安慰剂（n = 87）或多非利特（n = 87）。如其他地方报道的那样，两组中达到主要试验终点（室性心动过速或室颤的ICD干预）的患者数量相似。对于这项分析，合格的事件是TdP（心电图）或心内电图显示暂停依赖性PVT。根据前瞻性定义的暂停依赖性多态性VT发作标准，对131例患者共620个电图进行盲法分析。这些在接受多非利特的15/87（17%）患者和接受安慰剂的5/87（6%）患者中被确定（p < 0.05）。其中5次发作为早期（<3天），均为多非利特TdP。有15例晚期事件，多非利特组10例，安慰剂组5例（p = 0.29）。晚期事件的中位时间为22天（范围6至107天）多非利特和99天（范围34至207天）安慰剂。CONCLUSIONSPause-dependent PVT是更常见的患者接受多非利特，虽然总VT的发生率是相似的两组。这些数据表明，在ICD患者中，长期多非利特治疗与TdP风险增加或药物改变VT形态相关。
OBJECTIVESTo compare the incidence of pause-dependent polymorphic ventricular tachycardia (PVT) in patients with implantable cardioverter-defibrillators (ICDs) randomly assigned to the QT-prolonging antiarrhythmic dofetilide or placebo.BACKGROUNDDrug-related torsade de pointes (TdP) is usually recognized within days of initiating therapy, but its incidence during long-term therapy is unknown.METHODSWe assessed the frequency of TdP and ICD electrograms compatible with TdP in a multicenter study that randomized ICD patients to placebo (n = 87) or dofetilide (n = 87). As reported elsewhere, the number of patients with a primary trial end point (ICD intervention for VT or ventricular fibrillation) was similar in the two groups. For this analysis, a qualifying event was TdP (on electrocardiogram) or an intracardiac electrogram showing pause-dependent PVT.RESULTSA total of 620 electrograms obtained in 131 patients were analyzed blindly by prospectively defined criteria for episodes of pause-dependent polymorphic VT. These were identified in 15/87 (17%) patients receiving dofetilide and 5/87 (6%) patients on placebo (p < 0.05). Five of these episodes were early (<3 days), all of which were TdP on dofetilide. There were 15 late events, 10 on dofetilide and five on placebo (p = 0.29). The median time to a late event was 22 days (range 6 to 107 days) for dofetilide and 99 days (range 34 to 207 days) for placebo.CONCLUSIONSPause-dependent PVT was more common among patients receiving dofetilide, although total VT incidence was similar in the two groups. These data suggest that in ICD patients either long-term dofetilide therapy is associated with an increased risk of TdP or the drug alters VT morphology.