Medline ® Abstract for Reference 51
of 'Acquired long QT syndrome'
Effect of dofetilide in patients with recent myocardial infarction and left-ventricular dysfunction: a randomised trial.
Køber L, Bloch Thomsen PE, Møller M, Torp-Pedersen C, Carlsen J, Sandøe E, Egstrup K, Agner E, Videbaek J, Marchant B, Camm AJ, Danish Investigations of Arrhythmia and Mortality on Dofetilide (DIAMOND) Study Group
BACKGROUND: Arrhythmias cause much morbidity and mortality after myocardial infarction, but in previous trials, antiarrhythmic drug therapy has not been convincingly effective. Dofetilide, a new class III agent, was investigated for effects on all-cause mortality and morbidity in patients with left-ventricular dysfunction after myocardial infarction.
METHODS: In 37 Danish coronary-care units, 1510 patients with severe left-ventricular dysfunction (wall motion index<or = 1.2, corresponding to ejection fraction<or = 0.35) were enrolled in a randomised, double-blind study comparing dofetilide (n=749) with placebo (n=761). The primary endpoint was all-cause mortality. Secondary endpoints included cardiac and arrhythmic mortality and total arrhythmic deaths. Analyses were by intention to treat.
FINDINGS: No significant differences were found between the dofetilide and placebo groups in all-cause mortality (230 [31%]vs 243 [32%]), cardiac mortality (191 [26%]vs 212 [28%]), or total arrhythmic deaths (129 [17%]vs 140 [18%]). Atrial fibrillation or flutter was present in 8% of the patients at study entry. In these patients, dofetilide was significantly better than placebo at restoring sinus rhythm (25 of 59 vs seven of 56; p=0.002). There were seven cases of torsade de pointes ventricular tachycardia, all in the dofetilide group.
INTERPRETATION: In patients with severe left-ventricular dysfunction and recent myocardial infarction, treatment with dofetilide did not affect all-cause mortality, cardiac mortality, or total arrhythmic deaths. Dofetilide was effective in treating atrial fibrillation or flutter in this population.
Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark. firstname.lastname@example.org