Abstract 15766: A Perfect [vt] Storm - How All the Wrong Factors Converged During a Dofetilide Load

• DOI: 10.1161/circ.146.suppl_1.15766
• Publication Date: 2023-06-15T17:28:42Z
• Authors: Nathaniel McConkey; Ravi Shah; Marcin Kuzma; Justin Rackley; Mario Gonzalez
• Keywords: Dofetilide; Torsades de pointes; Proarrhythmia

Background: Dofetilide is a class III antiarrhythmic often used for the treatment of atrial fibrillation. Given its QTc prolonging properties, it invariably initiated in an inpatient setting. While admissions this drug are unexciting, pharmacologic cardioversion general and dofetilide particular carry unique hazards. Objective: To review case where several risk factors converged during load to produce life threatening event. Case: A 75 year old male persistent fibrillation was admitted started on 500 mcg PO Q12 (based GFR). He did not experience any prolongation after his first two doses, converted sinus rhythm second day hospitalization. With this, he had abrupt decrease heart rate from 110 60 bpm. Within minutes, suddenly developed flash pulmonary edema required acute failure with IV diuresis. Fortunately, improved therapy time receive third dose, which remained at 450. However, non sustained polymorphic ventricular ectopy overnight. His full AM dose given before monitor reviewed (given normal QTc), within 2 hrs fourth prolonged markedly. bigeminy long-coupled PVCs. Subsequently, torsades requiring chest compressions defibrillation. The patient recovered well, discontinued. Conclusion: Acute restoration uncommon but known complication cardioversion, both electrical pharmacologic. Furthermore, hemodynamic derangement arrhythmia threshold, which, along drop recent diuresis, likely contributed development torsades. while appeared numerically acceptable given, later revealed abnormal T wave morphology peak end time, might have prompted change if recognized. In short, monitoring patients involves more than just GFR - other observable can portend poor outcome.