1
|
Shantha G, Singleton M, Kozak P, Bodziock G, Atreya AR, Narasimhan B, Deshmukh A, Liang JJ, Hranitzky P, Whalen P, Bhave P. Role of dofetilide in patients with ventricular arrhythmias. J Interv Card Electrophysiol 2024; 67:91-97. [PMID: 37247098 DOI: 10.1007/s10840-023-01578-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/21/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND OR PURPOSE To assess effectiveness of dofetilide in reducing the burden of ventricular arrhythmias (VAs). BACKGROUND Prior small sample studies show that dofetilide has benefit in reducing VA. However, large sample investigations with long-term follow-up are lacking. METHODS Two hundred seventeen consecutive patients admitted between January 2015 and December 2021 for dofetilide initiation for control of VA were assessed. Dofetilide was successfully started in 176 patients (81%) and had to be discontinued in the remaining 41 patients (19%). Dofetilide was initiated for control of ventricular tachycardia (VT) in 136 patients (77%), whereas 40 (23%) patients were initiated on dofetilide for reducing the burden of premature ventricular complexes (PVCs). RESULTS The mean follow-up was 24 ± 7 months. In total, among the 136 VT patients, 33 (24%) died, 11 (8%) received a left ventricular assist device (LVAD), and 3 (2%) received a heart transplant during follow-up. Dofetilide was discontinued in 117 (86%) patients due to lack of sustained effectiveness during follow-up. Dofetilide use was associated with similar odds of the composite outcome of all-cause mortality/LVAD/heart transplant (OR: 0.97, 0.55-4.23) in patients with ischemic cardiomyopathy (ICM) compared to those with non-ischemic cardiomyopathy (NICM). Dofetilide did not reduce PVC burden during follow-up in the 40 patients with PVCs (mean baseline PVC burden: 15%, at 1-year follow-up: 14%). CONCLUSIONS Dofetilide use was less effective in reducing VA burden in our cohort of patients. Randomized controlled studies are needed to confirm our findings.
Collapse
Affiliation(s)
- Ghanshyam Shantha
- Cardiac Electrophysiology, Wake Forest University, 1, Medical Center Blvd, Winston-Salem, NC, 27157, USA.
| | | | - Patrick Kozak
- Cardiac Electrophysiology, Wake Forest University, 1, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - George Bodziock
- Cardiac Electrophysiology, Wake Forest University, 1, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Auras R Atreya
- Cardiac Electrophysiology, University of Arkansas, Little Rock, USA
| | - Bharat Narasimhan
- Debakey Cardiovascular Center, Houston Methodist Hospital, Houston, TX, USA
| | | | - Jackson J Liang
- Cardiac Electrophysiology, University of Michigan, Ann Arbor, MI, USA
| | | | - Patrick Whalen
- Cardiac Electrophysiology, Wake Forest University, 1, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Prashant Bhave
- Cardiac Electrophysiology, Wake Forest University, 1, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| |
Collapse
|
2
|
Kim M, Sager PT, Tester DJ, Pradhananga S, Hamrick SK, Srinivasan D, Das S, Ackerman MJ. SGK1 inhibition attenuates the action potential duration in reengineered heart cell models of drug-induced QT prolongation. Heart Rhythm 2023:S1547-5271(23)00002-4. [PMID: 36610526 DOI: 10.1016/j.hrthm.2022.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/15/2022] [Accepted: 12/29/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Drug-induced QT prolongation (DI-QTP) is a clinical entity in which administration of a human ether-à-go-go-related gene/rapid delayed rectifier potassium current blocker such as dofetilide prolongs the cardiac action potential duration (APD) and the QT interval on the electrocardiogram. Inhibition of serum and glucocorticoid regulated kinase-1 (SGK1) reduces the APD at 90% repolarization (APD90) in induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) derived from patients with congenital long QT syndrome. OBJECTIVE Here, we test the efficacy of 2 novel SGK1 inhibitors-SGK1-I1 and SGK1-I2-in iPSC-CM models of dofetilide-induced APD prolongation. METHODS Normal iPSC-CMs were treated with dofetilide to produce a DI-QTP iPSC-CM model. SGK1-I1's and SGK1-I2's therapeutic efficacy for shortening the dofetilide-induced APD90 prolongation was compared to mexiletine. The APD90 values were recorded 4 hours after treatment using a voltage-sensing dye. RESULTS The APD90 was prolonged in normal iPSC-CMs treated with dofetilide (673 ± 8 ms vs 436 ± 4 ms; P < .0001). While 10 mM mexiletine shortened the APD90 of dofetilide-treated iPSC-CMs from 673 ± 4 to 563 ± 8 ms (46% attenuation; P < .0001), 30 nM of SGK1-I1 shortened the APD90 from 673 ± 8 to 502 ± 7 ms (72% attenuation; P < .0001). Additionally, 300 nM SGK1-I2 shortened the APD90 of dofetilide-treated iPSC-CMs from 673 ± 8 to 460 ± 7 ms (90% attenuation; P < .0001). CONCLUSION These novel SGK1-Is substantially attenuated the pathological APD prolongation in a human heart cell model of DI-QTP. These preclinical data support the development of this therapeutic strategy to counter and neutralize DI-QTP, thereby increasing the safety profile for patients receiving drugs with torsadogenic potential.
Collapse
|
3
|
Khan ZA, LaBreck ME, Luli J, Roberts C, Smith A, El-Zein R, Tyler JD, Fu EY, Billakanty SR, Amin AK, Chopra N. Longitudinal QT c Stability and Impact of Baseline Cardiac Rhythm on Discharge Dose in Dofetilide-treated Patients. J Cardiovasc Electrophysiol 2022; 33:1281-1289. [PMID: 35362175 DOI: 10.1111/jce.15483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/03/2022] [Accepted: 03/30/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dofetilide suppresses AF in a dose-dependent fashion. The protective effect of AF against QTc prolongation induced torsades de pointe and transient post-cardioversion QTc prolongation may result in dofetilide under-dosing during initiation. Thus, the optimal timing of cardioversion for AF patients undergoing dofetilide initiation to optimize discharge dose remains unknown as does the longitudinal stability of QTc . OBJECTIVE To evaluate the impact of baseline rhythm on dofetilide dosing during initiation and assess the longitudinal stability of QTc-all (Bazzett, Fridericia, Framingham, and Hodges) over time. METHODS Medical records of patients who underwent pre-planned dofetilide loading at a tertiary care center between January 2016-2019 were reviewed. RESULTS A total of 198 patients (66±10 years, 32% female, CHADS2 -Vasc 3 [2-4]) presented for dofetilide loading in either AF (59%) or SR (41%). Neither presenting rhythm, nor spontaneous conversion to SR impacted discharge dose. The cumulative dofetilide dose prior to cardioversion moderately correlated (r=0.36; p=0.0001) with discharge dose. Post-cardioversion QTc-all prolongation (p<0.0001) prompted discharge dose reduction (890±224mcg vs 552±199mcg; p<0.0001) in 30% patients. QTc-all in SR prolonged significantly during loading (p<0.0001). All patients displayed QTc-all reduction (p<0.0001) from discharge to short-term (46 [34-65] days) that continued at long-term (360 [296-414] days) follow-ups. The extent of QTc-all reduction over time moderately correlated with discharge QTc-all (r=0.54-0.65; p<0.0001). CONCLUSION Dofetilide initiation prior to cardioversion is equivalent to initiation during SR. Significant QTc reduction proportional to discharge QTc is seen over time in all dofetilide-treated patients. QTc returns to pre-loading baseline during follow-up in patients initiated in SR. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Zeryab A Khan
- Department of Internal Medicine, OhioHealth Doctors Hospital, 5100 West Broad Street Columbus, OH, 43228
| | - Megan E LaBreck
- Department of Pharmacy, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH, 43214
| | - Jordan Luli
- Department of Internal Medicine, OhioHealth Doctors Hospital, 5100 West Broad Street Columbus, OH, 43228
| | - Chelsea Roberts
- Department of Pharmacy, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH, 43214
| | - Alexander Smith
- Department of Internal Medicine, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH, 43214, USA
| | - Rayan El-Zein
- Department of Internal Medicine, OhioHealth Doctors Hospital, 5100 West Broad Street Columbus, OH, 43228
| | - Jaret D Tyler
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH, 43214, USA
| | - Eugene Y Fu
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH, 43214, USA
| | - Sreedhar R Billakanty
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH, 43214, USA
| | - Anish K Amin
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH, 43214, USA
| | - Nagesh Chopra
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH, 43214, USA
| |
Collapse
|
4
|
Elvin Gul E, Azizi Z, Alipour P, Haseeb S, Malcolm R, Terricabras M, Sanchez Somonte P, Tsang B, Khaykin Y, Wulffhart Z, Verma A, Pantano A. Fluoroless Catheter Ablation of Atrial Fibrillation: Integration of Intracardiac Echocardiography and Cartosound Module. J Atr Fibrillation 2021; 14:20200477. [PMID: 34950370 DOI: 10.4022/jafib.20200477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/19/2021] [Accepted: 05/18/2021] [Indexed: 12/18/2022]
Abstract
Objective To evaluate the feasibility, safety, and clinical efficacy of non-fluoroscopic radiofrequency catheter ablation of atrial fibrillation (AF) in comparison to traditional fluoroscopy-guided ablation in a local Canadian community cohort. Methods We retrospectively studied consecutive patients with paroxysmal and persistent AF undergoing pulmonary vein isolation (PVI) guided by intracardiac echocardiography (ICE) and Carto system (CartoSound module). ICE-guided PVI without fluoroscopy (Zero-fluoro group) was performed in 116 patients, and conventional fluoroscopy-guided PVI (Traditional group) was performed in 131 patients. Results Two hundred and forty-seven patients with AF (60.7% male; mean age: 62.2 ± 10.6 years; paroxysmal AF =63.1%) who underwent PVI were studied. Mean procedure times were similar between both groups (136.8±33.4 minutes in the zero-fluoro group vs. 144.3±44.9 minutes in the traditional group; p=0.2). Acute PVI was achieved in all patients. Survival from early AF recurrence was 85% and 81% in the zero-fluoro and traditional groups, respectively (p = 0.06). Survival from late AF recurrence (12-months) between the zero-fluoro and traditional groups was also similar (p=0.1). Moreover, there were no significant differences between complication rates, including hematoma (p = 0.2) and tamponade (p = 1),between both groups. Conclusions Zero-fluoroscopy ICE and CartoSound-guided AF ablation may be safe and feasible in patients undergoing PVI compared to conventional fluoroscopy-guided ablation.
Collapse
Affiliation(s)
- Enes Elvin Gul
- Division of Cardiology, Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada.,Contributed equally as first co-authors
| | - Zahra Azizi
- Division of Cardiology, Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada.,Contributed equally as first co-authors
| | - Pouria Alipour
- Division of Cardiology, Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sohaib Haseeb
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Rebecca Malcolm
- Division of Cardiology, Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
| | - Maria Terricabras
- Division of Cardiology, Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
| | - Paula Sanchez Somonte
- Division of Cardiology, Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
| | - Bernice Tsang
- Division of Cardiology, Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
| | - Yaariv Khaykin
- Division of Cardiology, Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
| | - Zaev Wulffhart
- Division of Cardiology, Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
| | - Atul Verma
- Division of Cardiology, Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
| | - Alfredo Pantano
- Division of Cardiology, Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
5
|
Mascarenhas DAN, Mudumbi PC, Kantharia BK. Outpatient initiation of dofetilide: insights from the complexities of atrial fibrillation management during the COVID-19 lockdown. J Interv Card Electrophysiol 2021; 63:21-28. [PMID: 33484394 PMCID: PMC7823191 DOI: 10.1007/s10840-021-00942-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 01/11/2021] [Indexed: 12/19/2022]
Abstract
Background At peak COVID-19 lockdown, patients with symptomatic atrial fibrillation (AF) were faced with an equipoise between a palliative rate-control versus cautious rhythm-control strategy, including hospitalization for initiation of antiarrhythmic drug/s (AADs) and cardiac procedures which was impossible due to hospitalization restrictions. Objectives We aimed to evaluate the efficacy and safety of outpatient initiation of dofetilide in patients with AF using cardiac implantable electronic devices (CIEDs) for rhythm and QTc interval monitoring. Methods Adult patients with symptomatic AF with prior failure or intolerance to other AADs were enrolled if they were willing to in-office insertion of implantable loop recorders or already implanted with pacemakers or defibrillators capable of remote monitoring. Exclusion criteria were known medical contraindications of dofetilide and unable to provide consent. After making a shared management decision, dofetilide was initiated in a physician office, and rhythm and QTc intervals were monitored by ECGs and CIEDs. Patients were followed to assess the efficacy and safety of the treatment. Results The study cohort comprised of 30 patients, age 76 ± 7 years (mean ± standard deviation), 10 female (33%), CHA2DS2-VASc score 3.25 ± 1.3, ejection fraction 63.45% ± 8.52, and QTc interval 431.68 ± 45.09 ms. From 22 (73%) patients in AF at presentation, SR was restored in 14 (64%) patients after 4 doses of dofetilide. At 46 ± 59 days of follow-up, maintenance of SR in total 22 (73%) patients without cardiac adverse effects was accomplished. Conclusion Effective and safe outpatient initiation of dofetilide during the extenuating circumstance of COVID-19 lockdown was possible in patients with AF who had CIEDs.
Collapse
Affiliation(s)
| | - Praveen C Mudumbi
- Cardiovascular and Heart Rhythm Consultants, 30 West 60th Street, Suite 1U, New York, NY, 10023, USA
| | - Bharat K Kantharia
- Cardiovascular and Heart Rhythm Consultants, 30 West 60th Street, Suite 1U, New York, NY, 10023, USA.
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| |
Collapse
|
6
|
van Veldhoven JPD, Campostrini G, van Gessel CJE, Ward-van Oostwaard D, Liu R, Mummery CL, Bellin M, IJzerman AP. Targeting the K v11.1 (hERG) channel with allosteric modulators. Synthesis and biological evaluation of three novel series of LUF7346 derivatives. Eur J Med Chem 2021; 212:113033. [PMID: 33261899 DOI: 10.1016/j.ejmech.2020.113033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/22/2020] [Accepted: 11/16/2020] [Indexed: 01/08/2023]
Abstract
We synthesized and evaluated three novel series of substituted benzophenones for their allosteric modulation of the human Kv11.1 (hERG) channel. We compared their effects with reference compound LUF7346 previously shown to shorten the action potential of cardiomyocytes derived from human stem cells. Most compounds behaved as negative allosteric modulators (NAMs) of [3H]dofetilide binding to the channel. Compound 9i was the most potent amongst all ligands, remarkably reducing the affinity of dofetilide in competitive displacement assays. One of the other derivatives (6k) tested in a second radioligand binding set-up, displayed unusual displacement characteristics with a pseudo-Hill coefficient significantly distinct from unity, further indicative of its allosteric effects on the channel. Some compounds were evaluated in a more physiologically relevant context in beating cardiomyocytes derived from human induced pluripotent stem cells. Surprisingly, the compounds tested showed effects quite different from the reference NAM LUF7346. For instance, compound 5e prolonged, rather than shortened, the field potential duration, while it did not influence this parameter when the field potential was already prolonged by dofetilide. In subsequent patch clamp studies on HEK293 cells expressing the hERG channel the compounds behaved as channel blockers. In conclusion, we successfully synthesized and identified new allosteric modulators of the hERG channel. Unexpectedly, their effects differed from the reference compound in functional assays on hERG-HEK293 cells and human cardiomyocytes, to the extent that the compounds behaved as stand-alone channel blockers.
Collapse
|
7
|
Teo TW, Tan BYQ, Sia CH. 32-year-old with Paroxysmal Atrial Fibrillation after Traumatic Spinal Cord Injury. J Atr Fibrillation 2020; 13:2324. [PMID: 34950294 DOI: 10.4022/jafib.2324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 04/30/2020] [Accepted: 05/02/2020] [Indexed: 11/10/2022]
Abstract
A 32-year-old man presented with sudden loss of consciousness after passing urine with resultant trauma to the back of his neck. There were no palpitations prior. Examination revealed flaccid paralysis of all 4 limbs with priapism. Electrocardiogram demonstrated atrial fibrillation with rapid ventricular response. Laboratory showed normal potassium, magnesium, calcium, thyroid stimulating hormone and troponin I levels. Magnetic resonance imaging of the cervical spine demonstrated left C4 facet dislocation with grade 1 spondylolisthesis of C4 over C5, with moderate to severe narrowing of the spinal canal with cord compression and oedema. Transthoracic echocardiogram demonstrated an ejection fraction of 60% and no valvular abnormalities. Left atrium size was normal. The atrial fibrillation subsequently spontaneously reverted to sinus rhythm without treatment. Clinicians should be aware that atrial fibrillation can occur in the context of traumatic spinal cord injury due to disruption of the autonomic pathways in the cervical spine.
Collapse
Affiliation(s)
- Ting-Wei Teo
- Internal Medicine Residency, National University Health System, Singapore
| | - Benjamin Yong-Qiang Tan
- Division of Neurology, Department of Medicine, National University Hospital, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore
| |
Collapse
|
8
|
Dar T, Murtaza G, Yarlagadda B, Madoukh B, Bravin L, Vuddanda V, Parikh V, Reddy M, Lakkireddy D. Dofetilide Initiation and Implications of Deviation From the Standard Protocol - A Real World Experience. J Atr Fibrillation 2020; 12:2265. [PMID: 32435348 DOI: 10.4022/jafib.2265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/11/2019] [Accepted: 10/12/2019] [Indexed: 11/10/2022]
Abstract
Background Manufacturer/federal drug administration (FDA) recommends inpatient initiation of dofetilide with the manufacturer providing an initiation algorithm. The outcomes of algorithm deviation have not been reported outside of clinical trials. Objective We sought to perform a chart review of all the patients admitted for inpatient initiation of dofetilide to report on the incidence of protocol deviations and their implications. Methods We performed a retrospective review of all patients over a 15-month periodwho were initiated on dofetilide for the very first time or reinitiated on dofetilide after a break of three months or more at our institution. We assessed data about patients who were given dofetilide without adherence to the protocol (i.e. protocol deviation). Results A total of 189 patients were included in the study with a median age of 66 ± 9 years. Mean baseline QTc interval was 436 ± 32 msec, and 61% (116/189) were in atrial fibrillation (AF) at the time of dofetilide initiation. In 9% (17/189) of patients, the drug was discontinued due to intolerance or inefficacy. Therapy in 49% (93/189) of patients was noted to deviate from manufacturer recommended protocol with deviations more than once in some patients during the same hospitalization. Baseline QTc exceeding 440 msec(>500msec in conduction abnormalities) was the most frequent deviation (25%; 47/189).Ventricular tachyarrhythmia occurred in 4% (7/189) of patients, did not differ between patients, and occurred with and without protocol deviations (5% vs 2%; p = 0.27). Conclusions In our retrospective study, there were frequent deviations from the manufacturer-recommended algorithm guidelines for dofetilideinitation, primarily due to prolonged baseline QTc interval. The impact of these protocol deviations on drug discontinuation was uncertain; however, significant adverse events were higher in the deviation group compared to the group that fully adhered to the protocol. Further multicenter studies are warranted to clarify our findings.
Collapse
Affiliation(s)
- Tawseef Dar
- Department of Nuclear Cardiology, Massachusetts General Hospital, Boston, MA
| | - Ghulam Murtaza
- Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, KS
| | | | - Bader Madoukh
- Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, KS
| | - Lesley Bravin
- Division of Cardiovascular Diseases, University of Kansas Hospital and Medical Center, Kansas City, KS
| | - Venkat Vuddanda
- Department of General Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Valay Parikh
- Division of Cardiovascular Diseases, University of Kansas Hospital and Medical Center, Kansas City, KS
| | - Madhu Reddy
- Division of Cardiovascular Diseases, University of Kansas Hospital and Medical Center, Kansas City, KS
| | | |
Collapse
|
9
|
Thalluri B, Dhiman V, Tiwari S, Baira SM, Kumar Talluri MVN. Study on forced degradation behaviour of dofetilide by LC-PDA and Q-TOF/MS/MS: Mechanistic explanations of hydrolytic, oxidative and photocatalytic rearrangement of degradation products. J Pharm Biomed Anal 2020; 179:112985. [PMID: 31780282 DOI: 10.1016/j.jpba.2019.112985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/06/2019] [Accepted: 11/10/2019] [Indexed: 11/24/2022]
Abstract
A solution and solid state forced decomposition study was carried on dofetilide under diverse stress conditions of hydrolysis, oxidation, photolysis and thermal as per International Council for Harmonisation guidelines (ICH) Q1A(R2) to understand its degradation behaviour. A total of eight degradation products (DPs) were identified and separated on reversed phase kromasil 100 C8 column (4.6 mm x 250 mm x5 μm) using gradient elution with ammonium acetate (10 mM, pH 6.2) and acetonitrile as mobile phase. The detection wavelength was selected as 230 nm. The high performance liquid chromatography (HPLC) study found that the drug was susceptible to hydrolytic stress condition, but it was highly unstable to photolytic and oxidative conditions. The solid drug was stable in thermal and photolytic conditions. Initially comprehensive mass fragmentation pattern of the drug was accomplished with the LC/ESI/QTOF/MS/MS studies in positive ionization mode. The same was followed for all the eight degradation products to characterise their structure. The DP4 was N-oxide and the structure was confirmed by LC/APCI/QTOF/MS/MS in positive ionization mode. The complete mass fragmentation pattern of the drug and its DPs were established which in turn helped the characterisation of their structures. The mechanistic pathway for the formation of all the DPs was explained.
Collapse
Affiliation(s)
- Bhargavi Thalluri
- Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education & Research, IDPL R&D Campus, Balanagar, Hyderabad, 500 037, India
| | - Vivek Dhiman
- Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education & Research, IDPL R&D Campus, Balanagar, Hyderabad, 500 037, India
| | - Shristy Tiwari
- Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education & Research, IDPL R&D Campus, Balanagar, Hyderabad, 500 037, India
| | - Shandaliya Mahamuni Baira
- Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education & Research, IDPL R&D Campus, Balanagar, Hyderabad, 500 037, India
| | - M V N Kumar Talluri
- Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education & Research, IDPL R&D Campus, Balanagar, Hyderabad, 500 037, India.
| |
Collapse
|
10
|
Uddin ME, Sun X, Huang KM, Hu S, Carnes CA, Sparreboom A, Fu Q. Development and validation of a UPLC-MS/MS analytical method for dofetilide in mouse plasma and urine, and its application to pharmacokinetic study. J Pharm Biomed Anal 2019; 172:183-188. [PMID: 31055183 DOI: 10.1016/j.jpba.2019.04.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/16/2019] [Accepted: 04/18/2019] [Indexed: 10/27/2022]
Abstract
A novel method using UPLC with tandem mass-spectrometric detection (UPLC-MS/MS) with positive electrospray ionization was developed for the detection of the antiarrhythmic drug, dofetilide, in mouse plasma and urine. Protein precipitation was performed on 10 μL of plasma and 2 μL of urine samples using dofetilide-D4 as an internal standard, and separation of the analyte was accomplished on a C18 analytical column with the flow of 0.40 mL/min. Subsequently, the method was successfully applied to determine the pharmacokinetic parameters of dofetilide following oral and intravenous administration. The calibration curve was linear over the selected concentration range (R2 ≥ 0.99), with a lower limit of quantitation of 5 ng/mL. The intra-day and inter-day precisions, and accuracies obtained from a 5-day validation ranged from 3.00 to 7.10%, 3.80-7.20%, and 93.0-106% for plasma, and 3.50-9.00%, 3.70-10.0%, 87.0-106% for urine, while the recovery of dofetilide was 93.7% and 97.4% in plasma and urine, respectively. The observed pharmacokinetic profiles revealed that absorption is the rate-limiting step in dofetilide distribution and elimination. Pharmacokinetic studies illustrate that the absolute bioavailability of dofetilide in the FVB strain mice is 34.5%. The current developed method allows for accurate and precise quantification of dofetilide in micro-volumes of plasma and urine, and was found to be suitable for supporting in vivo pharmacokinetic studies.
Collapse
Affiliation(s)
- Muhammad Erfan Uddin
- Division of Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Xinxin Sun
- Division of Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Kevin M Huang
- Division of Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Shuiying Hu
- Division of Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Cynthia A Carnes
- Division of Pharmacy Practice and Science, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Alex Sparreboom
- Division of Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Qiang Fu
- Division of Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy, The Ohio State University, Columbus, OH, USA.
| |
Collapse
|
11
|
Kinney N, Larsen TR, Kim DM, Varghese RT, Poelzing S, Garner HR, AlMahameed ST. Whole-exome sequencing reveals microsatellite DNA markers for response to dofetilide initiation in patients with persistent atrial fibrillation: A pilot study. Clin Cardiol 2018; 41:849-854. [PMID: 29671888 DOI: 10.1002/clc.22969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 04/08/2018] [Accepted: 04/16/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Dofetilide is a class III antiarrhythmic drug effective for the treatment of atrial fibrillation (AF). Dofetilide initiation (DI) associates with corrected QT interval (QTc) prolongation. Significant QTc prolongation during DI mandates dose adjustment or discontinuation of the drug. Microsatellite DNA are novel genetic markers associated with congenital and acquired health conditions. HYPOTHESIS DNA microsatellite polymorphism may associate with QTc response to dofetilide initiation in patients with persistent AF. METHODS We performed whole-exome sequencing in a cohort of patients with persistent AF undergoing DI. Electrocardiographic variables and clinical data were assessed. We defined patients as eligible for DI when no significant QTc prolongation (>20% compared with baseline) was seen with a 500-μg dose. We defined patients as ineligible for DI when significant QTc prolongation was seen during DI with 500 μg. We investigated polymorphisms for 11 919 DNA microsatellite loci in relation to QTc response to DI. RESULTS During the study, 14 consecutive patients with persistent AF presenting for DI were enrolled. Whole-exome sequencing revealed 14 different microsatellite loci in the 2 groups. All genes or proximal genes that harbor these loci are known to have expression in the human heart. Two genes, MYH6 and TRAK2, are known to have expression in the atria. TRAK2 is known to interact with KCNJ2, the inward-rectifier potassium channel 1. CONCLUSIONS Microsatellite DNA polymorphisms seem to associate with QTc response to DI therapy in patients with persistent AF who are deemed otherwise eligible for dofetilide therapy.
Collapse
Affiliation(s)
- Nick Kinney
- Edward Via College of Osteopathic Medicine, Blacksburg, Virginia
| | - Timothy R Larsen
- Carilion Clinic and Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - David M Kim
- Carilion Clinic and Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Robin T Varghese
- Edward Via College of Osteopathic Medicine, Blacksburg, Virginia
| | - Steven Poelzing
- Virginia Tech Carilion Research Institute, and the Center for Heart and Regenerative Medicine, Virginia Polytechnic University, Roanoke, Virginia
| | - Harold R Garner
- Edward Via College of Osteopathic Medicine, Blacksburg, Virginia
- Gibbs Cancer Center and Research Institute, Spartanburg, South Carolina
| | - Soufian T AlMahameed
- Carilion Clinic and Virginia Tech Carilion School of Medicine, Roanoke, Virginia
- MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio
| |
Collapse
|
12
|
Cheng G, Wu J, Han W, Sun C. F463L increases the potential of dofetilide on human ether-a-go-go-related gene (hERG) channels. Microsc Res Tech 2018; 81:663-668. [PMID: 29573040 DOI: 10.1002/jemt.23021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 02/02/2018] [Accepted: 03/02/2018] [Indexed: 11/11/2022]
Abstract
Mutations in genes related to long QT syndrome (LQTS) is recognized as an independent risk of drug-induced LQTS. We previously screened a mutation F463L in a Chinese patient with LQT2, syncope, and epilepsy. Here, we planned to illustrate how F463L influences the action of dofetilide on hERG channels. F463L-hERG plasmids were transfected into the stable Human Embryonic Kidney 293 (HEK293) cells expressing WT-hERG to generate heterozygous mutant (WT + F463L-hERG). Whole-cell patch clamp and laser confocal scanning microscopy were used to evaluate electrophysiological consequences and the membrane distribution of hERG protein. In comparison of WT-hERG channels exposed to dofetilide, heterozygous F463L-hERG channels showed a reduction in the density of tail currents when exposed amidarone. F463L-hERG also altered the action of dofetilide on the gating properties of hERG channels. Images of dofetilide-treated cells expressing heterozygous F463L showed a severe retention and reduction of protein expression on the membrane compared to WT. In conclusion, dofetilide displays a powerful inhibitory effect on the currents from cells expressing heterozygous F463L, thus showing an additive suppression of currents by F463L with dofetilide.
Collapse
Affiliation(s)
- Gong Cheng
- Department of Cardiovascular Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P.R.,Cardiovascular Medicine, Shaanxi Provincial People's Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710068, China
| | - Jine Wu
- Department of Cardiovascular Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P.R
| | - Wenqi Han
- Department of Cardiovascular Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P.R
| | - Chaofeng Sun
- Department of Cardiovascular Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P.R
| |
Collapse
|
13
|
Yarlagadda B, Vuddanda V, Dar T, Jazayeri MA, Parikh V, Turagam MK, Lavu M, Avula SR, Atkins D, Bommana S, Gopinathannair R, Yeruva MR, Lakkireddy D. Safety and Efficacy of Inpatient Initiation of Dofetilide versus Sotalol for atrial fibrillation. J Atr Fibrillation 2017; 10:1805. [PMID: 29487686 DOI: 10.4022/jafib.1805] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 11/19/2017] [Accepted: 12/14/2017] [Indexed: 11/10/2022]
Abstract
Background We sought to investigate and compare the safety and efficacy of two commonly used antiarrhythmic drugs, Dofetilide (DF) and Sotalol (SL), during inpatient drug initiation in patients with symptomatic atrial fibrillation (AF). Methods We performed a single center retrospective study of consecutive patients, admitted for initiation of either DF or SL, for AF between 2012 and 2015. Rates of successful cardioversion, QT interval prolongation, adverse events and drug discontinuations were calculated and compared. A two-tailed p value less than 0.05 was considered statistically significant. Results Of 378 patients, 298 (78.8%) received DF and 80 (21.2%) SL, mean age was 64 ± 11 years, 90% were Caucasians and 66% were males. Among the patients who remained in AF upon admission (DF: 215/298 (72%) vs. SL: 48/80 (60%)), no significant differences were noted in pharmacological cardioversion rates (DF: 125/215(58%) vs. SL: 30/48 (62.5%); p = 0.58). Baseline QTc was similar between the groups, with higher dose dependent QTc prolongation with DF (472.25± 31.3 vs. 458± 27.03; p = 0.008). There were no significant differences in the rates of adverse events such as bradycardia (7.4% vs. 11.3%; p = 0.26), Torsades de pointes (1.3% vs. 1.2%; p = 1.00), and drug discontinuation (9.0% vs. 5.0%; p = 0.47) between the two groups.
Collapse
Affiliation(s)
- Bharath Yarlagadda
- Cardiovascular research institute, The Kansas University Hospital, Kansas City, KS
| | - Venkat Vuddanda
- Cardiovascular research institute, The Kansas University Hospital, Kansas City, KS
| | - Tawseef Dar
- Cardiovascular research institute, The Kansas University Hospital, Kansas City, KS
| | | | - Valay Parikh
- Cardiovascular research institute, The Kansas University Hospital, Kansas City, KS
| | - Mohit K Turagam
- Division of Electrophysiology, Icahn School of Medicine, New York, NY
| | - Madhav Lavu
- Western Kentucky Heart and Lung Institute, Bowling Green, KY
| | | | - Donita Atkins
- Cardiovascular research institute, The Kansas University Hospital, Kansas City, KS
| | - Sudharani Bommana
- Cardiovascular research institute, The Kansas University Hospital, Kansas City, KS
| | | | - Madhu Reddy Yeruva
- Cardiovascular research institute, The Kansas University Hospital, Kansas City, KS
| | | |
Collapse
|
14
|
Kirchhoff JE, Diness JG, Abildgaard L, Sheykhzade M, Grunnet M, Jespersen T. Antiarrhythmic effect of the Ca 2+-activated K + (SK) channel inhibitor ICA combined with either amiodarone or dofetilide in an isolated heart model of atrial fibrillation. Pflugers Arch 2016; 468:1853-63. [PMID: 27722784 DOI: 10.1007/s00424-016-1883-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 08/13/2016] [Accepted: 08/27/2016] [Indexed: 12/22/2022]
Abstract
Dose is an important parameter in terms of both efficacy and adverse effects in pharmacological treatment of atrial fibrillation (AF). Both of the class III antiarrhythmics dofetilide and amiodarone have documented anti-AF effects. While dofetilide has dose-related ventricular side effects, amiodarone primarily has adverse non-cardiac effects. Pharmacological inhibition of small conductance Ca2+-activated K+ (SK) channels has recently been reported to be antiarrhythmic in a number of animal AF models. In a Langendorff model of acutely induced AF on guinea pig hearts, it was investigated whether a combination of the SK channel blocker N-(pyridin-2-yl)-4-(pyridin-2-yl)thiazol-2-amine (ICA) together with either dofetilide or amiodarone provided a synergistic effect. The duration of AF was reduced with otherwise subefficacious concentrations of either dofetilide or amiodarone when combined with ICA, also at a subefficacious concentration. At a concentration level effective as monotherapy, dofetilide produced a marked increase in the QT interval. This QT prolonging effect was absent when combined with ICA at non-efficacious monotherapy concentrations. The results thereby reveal that combination of subefficacious concentrations of an SK channel blocker and either dofetilide or amiodarone can maintain anti-AF properties, while the risk of ventricular arrhythmias is reduced.
Collapse
|
15
|
Abstract
Dofetilide is a class III antiarrhythmic used for treating atrial dysrhythmias. Though its adverse effects are well described in routine use, very little is known about dofetilide toxicity in overdose. This is a retrospective case series of consecutive patients reported to our poison center after dofetilide overdose. Twenty-seven cases were included. Seventeen patients were treated at a healthcare facility, and of these, eight were admitted. Twenty-one patients took one extra capsule, four took someone else's medication, one took three extra capsules, and one had a large intentional overdose. Ten patients had co-ingestants reported, including three QT-prolonging agents. No one required cardioversion, defibrillation, CPR, or overdrive pacing. The patient who reported taking 90 times his usual dose in suicide attempt was the only patient to have significant clinical effects. He experienced an 8-beat run of non-sustained ventricular tachycardia, frequent multifocal PVCs, and ventricular bigeminy. He received magnesium sulfate and potassium chloride supplementation. In this series, unintentional small overdoses did not result in significant clinical effects and were often managed successfully at home, despite the fact that information showing a single capsule can cause torsades. This study is limited by its small sample size, retrospective design, and reliance on incomplete information.
Collapse
Affiliation(s)
- M A Hieger
- Division of Clinical Toxicology, Department of Emergency Medicine, VCU Medical Center, 1250 E. Marshall Street, 2nd Floor, Richmond, VA, 23298, USA.
- Virginia Poison Center, 830 E. Main Street, Suite 300, PO Box 980522, Richmond, VA, 23298, USA.
- Department of Emergency Medicine, VCU Medical Center, Richmond, VA, 23298, USA.
| | - K F Maskell
- Division of Clinical Toxicology, Department of Emergency Medicine, VCU Medical Center, 1250 E. Marshall Street, 2nd Floor, Richmond, VA, 23298, USA
- Virginia Poison Center, 830 E. Main Street, Suite 300, PO Box 980522, Richmond, VA, 23298, USA
- Department of Emergency Medicine, VCU Medical Center, Richmond, VA, 23298, USA
| | - M J Moss
- Department of Emergency Medicine, VCU Medical Center, Richmond, VA, 23298, USA
| | - S W Powell
- Department of Emergency Medicine, VCU Medical Center, Richmond, VA, 23298, USA
| | - K L Cumpston
- Division of Clinical Toxicology, Department of Emergency Medicine, VCU Medical Center, 1250 E. Marshall Street, 2nd Floor, Richmond, VA, 23298, USA
- Virginia Poison Center, 830 E. Main Street, Suite 300, PO Box 980522, Richmond, VA, 23298, USA
- Department of Emergency Medicine, VCU Medical Center, Richmond, VA, 23298, USA
| |
Collapse
|
16
|
Obergrussberger A, Juhasz K, Thomas U, Stölzle-Feix S, Becker N, Dörr L, Beckler M, Bot C, George M, Fertig N. Safety pharmacology studies using EFP and impedance. J Pharmacol Toxicol Methods 2016; 81:223-32. [PMID: 27084108 DOI: 10.1016/j.vascn.2016.04.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/01/2016] [Accepted: 04/05/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION While extracellular field potential (EFP) recordings using multi-electrode arrays (MEAs) are a well-established technique for monitoring changes in cardiac and neuronal function, impedance is a relatively unexploited technology. The combination of EFP, impedance and human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) has important implications for safety pharmacology as functional information about contraction and field potentials can be gleaned from human cardiomyocytes in a beating monolayer. The main objectives of this study were to demonstrate, using a range of different compounds, that drug effects on contraction and electrophysiology can be detected using a beating monolayer of hiPSC-CMs on the CardioExcyte 96. METHODS hiPSC-CMs were grown as a monolayer on NSP-96 plates for the CardioExcyte 96 (Nanion Technologies) and recordings were made in combined EFP and impedance mode at physiological temperature. The effect of the hERG blockers, E4031 and dofetilide, hERG trafficking inhibitor, pentamidine, β-adrenergic receptor agonist, isoproterenol, and calcium channel blocker, nifedipine, was tested on the EFP and impedance signals. RESULTS Combined impedance and EFP measurements were made from hiPSC-CMs using the CardioExcyte 96 (Nanion Technologies). E4031 and dofetilide, known to cause arrhythmia and Torsades de Pointes (TdP) in humans, decreased beat rate in impedance and EFP modes. Early afterdepolarization (EAD)-like events, an in vitro marker of TdP, could also be detected using this system. Isoproterenol and nifedipine caused an increase in beat rate. A long-term study (over 30h) of pentamidine, a hERG trafficking inhibitor, showed a concentration and time-dependent effect of pentamidine. DISCUSSION In the light of the new Comprehensive in Vitro Proarrhythmia Assay (CiPA) initiative to improve guidelines and standardize assays and protocols, the use of EFP and impedance measurements from hiPSCs may become critical in determining the proarrhythmic risk of potential drug candidates. The combination of EFP offering information about cardiac electrophysiology, and impedance, providing information about contractility from the same area of a synchronously beating monolayer of human cardiomyocytes in a 96-well plate format has important implications for future cardiac safety testing.
Collapse
|
17
|
Abstract
Dofetilide is a class III antiarrhythmic agent with a selective blockade of rapid component of delayed rectifier potassium current (IKr). Dofetilide was found to be safe in patients after myocardial infarction and those with congestive heart failure and left ventricular systolic dysfunction (ejection fraction of less than 35%). An important adverse effect of dofetilide is its potential proarrhythmic risk of ventricular tachyarrhythmias, mostly torsades de pointes. Because dofetilide has about an 80% renal excretion, dose adjustment is required in patients with impaired renal function. Dofetilide should not be given or discontinued if the QTc is greater than 500 ms.
Collapse
|
18
|
Huang HD, Waks JW, Steinhaus DA, Zimetbaum P. Magnitude of increase in QTc interval after initiation of dofetilide in patients with persistent atrial fibrillation is associated with increased rates of pharmacological cardioversion and long-term freedom from recurrent atrial fibrillation. Heart Rhythm 2016; 13:1410-7. [PMID: 26921760 DOI: 10.1016/j.hrthm.2016.02.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Dofetilide is a class III antiarrhythmic drug approved for the treatment of atrial fibrillation (AF). Dofetilide-induced corrected QT (QTc) interval prolongation is a surrogate for the degree of drug effect, but the relationships between drug-induced QTc interval prolongation, pharmacological cardioversion (PCV), and freedom from recurrent AF are unclear. OBJECTIVE The purpose of this study was to assess associations between QTc interval change during dofetilide initiation and PCV and long-term AF recurrence. METHODS We performed retrospective analyses of a prospective cohort of patients with AF admitted for dofetilide initiation between 2001 and 2014. Clinical characteristics and electrocardiographic variables were assessed. We evaluated outcomes of successful PCV in patients with persistent AF and time to recurrence of AF in patients with paroxysmal and persistent AF. RESULTS During the study, 243 patients with persistent AF and 176 patients with paroxysmal AF initiated dofetilide. PCV occurred in 93/243 (41.7%) patients with persistent AF. After multivariable adjustment, QTc interval change was associated with PCV (adjusted odds ratio 1.21; P = .003 per 10-ms QTc increase). Inhospital QTc interval change was associated with long-term freedom from AF in patients with persistent AF (adjusted hazard ratio 0.92; P = .011 at 4 years per 10-ms QTc increase), but not in patients with paroxysmal AF. In patients with persistent AF, PCV was also associated with long-term freedom from recurrent AF (adjusted hazard ratio 0.62; P = .009 at 4 years). CONCLUSION The magnitude of QTc interval prolongation during dofetilide initiation is an independent predictor of successful PCV and long-term freedom from arrhythmia in patients with persistent AF. QTc interval change had no association with AF recurrence in patients with paroxysmal AF, suggesting that different mechanisms of arrhythmogenesis may be operant in different AF types.
Collapse
Affiliation(s)
- Henry D Huang
- Harvard-Thorndike Electrophysiology Institute, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jonathan W Waks
- Harvard-Thorndike Electrophysiology Institute, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Daniel A Steinhaus
- Harvard-Thorndike Electrophysiology Institute, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Peter Zimetbaum
- Harvard-Thorndike Electrophysiology Institute, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
19
|
Parker-Manuel SJ, Hahnel S, Grevelding CG. Inhibition of Schistosoma mansoni ether-a-go-go related gene-encoded potassium channels leads to hypermotility and impaired egg production. Exp Parasitol 2015; 158:48-54. [PMID: 26188142 DOI: 10.1016/j.exppara.2015.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 06/26/2015] [Accepted: 07/01/2015] [Indexed: 11/19/2022]
Abstract
The purpose of this work was to investigate the effect of ether-a-go-go related gene (ERG) potassium channel inhibition on Schistosoma mansoni. Use of dofetilide to block the schistosome ERGs resulted in a striking 'corkscrew' effect. The worms were unable to control their motility; they were hypermotile. The treated worms produced abnormal eggs, some of which consisted of little more than a spine. One of the S. mansoni ERGs (SmERGs), Smp_161140, was chosen for further study by RNAi. The transcript was knocked down to 50% compared to the controls. These RNAi-treated worms demonstrated seizure-like movements. In S. mansoni, as in other organisms, ERG channels seem to play a role in regulating muscle excitability. This work shows that egg production can be greatly reduced by effectively targeting muscle coordination in these important parasites.
Collapse
Affiliation(s)
- S J Parker-Manuel
- Institute of Parasitology, Justus-Liebig-University Giessen, Germany.
| | - S Hahnel
- Institute of Parasitology, Justus-Liebig-University Giessen, Germany
| | - C G Grevelding
- Institute of Parasitology, Justus-Liebig-University Giessen, Germany
| |
Collapse
|
20
|
Jaiswal A, Goldbarg S. Dofetilide induced torsade de pointes: mechanism, risk factors and management strategies. Indian Heart J 2014; 66:640-8. [PMID: 25634399 DOI: 10.1016/j.ihj.2013.12.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 12/04/2013] [Indexed: 11/29/2022] Open
Abstract
Dofetilide is an effective antiarrhythmic agent for conversion of atrial fibrillation and atrial flutter as well as maintenance of sinus rhythm in appropriately selected patients. However, as with other antiarrhythmic agents, proarrhythmia is a known adverse effect. The risk of dofetilide induced torsade de pointes (Tdp) is low when used with strict dosing criteria guided by renal function, QT interval and concomitant drug therapy. Benefit from dofetilide use must be individualized and weighed against the side effects and the role of other available treatment options. In this review, we discuss the underlying mechanism, risk factors and precautionary measures to avoid dofetilide induced QT prolongation and ventricular tachycardia/Tdp. We suggest a scheme for the management of QT prolongation, ventricular arrhythmia and Tdp as well.
Collapse
Affiliation(s)
- Abhishek Jaiswal
- Division of Cardiology, New York Hospital Queens/Weill Medical College of Cornell University, Flushing, NY 11355, USA.
| | - Seth Goldbarg
- Division of Cardiology, New York Hospital Queens/Weill Medical College of Cornell University, Flushing, NY 11355, USA
| |
Collapse
|
21
|
Parkinson J, Visser SAG, Jarvis P, Pollard C, Valentin JP, Yates JWT, Ewart L. Translational pharmacokinetic-pharmacodynamic modeling of QTc effects in dog and human. J Pharmacol Toxicol Methods 2013; 68:357-66. [PMID: 23567074 DOI: 10.1016/j.vascn.2013.03.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 01/25/2013] [Accepted: 03/25/2013] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Preclinical assessment of the heart rate corrected QT interval (QTc) is an important component of the cardiovascular safety evaluation in drug discovery. Here we aimed to quantify the translational relationship between QTc prolongation and shortening in the conscious telemetered dog and humans by a retrospective pharmacokinetic-pharmacodynamic (PKPD) analysis. METHODS QTc effects of 2 proprietary compounds and 2 reference drugs (moxifloxacin and dofetilide) were quantified in conscious dogs and healthy volunteers via a linear and Emax pharmacokinetic-pharmacodynamic models. The translational relationship was quantified by correlating the QTc response from dog and human at matching free drug concentrations. RESULTS A consistent translational relationship was found at low delta-QTc intervals indicating that a QTc change of 2.5-8 ms in dog would correspond to a 10 ms change in human. DISCUSSION The translational relationship developed here can be used to predict the QTc liability in human using preclinical dog data. It could therefore help protect the health of human volunteers, for example by appropriate clinical study design and dose selection, as well as improve future decision-making and help reduce compound attrition due to changes in QT interval.
Collapse
Affiliation(s)
- Joanna Parkinson
- AstraZeneca R&D, Safety Pharmacology, Alderley Park, UK; AstraZeneca R&D, Computational Toxicology, Safety Assessment, Mölndal, Sweden.
| | | | | | | | | | | | | |
Collapse
|