Exaggerated QT prolongation after cardioversion of atrial fibrillation

Choy, Anna Maria J; Darbar, Dawood; Dell’Orto, Simonetta; Roden, Dan M

doi:10.1016/s0735-1097(99)00226-0

Cited by 89Atrial Fibrillation Management and OutcomesCardiac electrophysiology and arrhythmiasCardiac Arrhythmias and Treatments

Exaggerated QT prolongation after cardioversion of atrial fibrillation

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Choy, Anna Maria J, Darbar, Dawood, Dell’Orto, Simonetta, Roden, Dan M·1999·Journal of the American College of Cardiology

DOI 10.1016/s0735-1097(99)00226-0

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Abstract

Objectives The purpose of this study was to test the hypothesis that the extent of drug-induced QT prolongation by dofetilide is greater in sinus rhythm (SR) after cardioversion compared with during atrial fibrillation (AF).Background Anecdotes suggest that when action potential-prolonging antiarrhythmic drugs are used for AF, excessive QT prolongation and torsades de pointes (TdP) often occur shortly after sinus rhythm is restored.Methods QT was measured in nine patients with AF who received two identical infusions of dofetilide: 1) before elective direct current cardioversion and 2) within 24 h of restoration of SR.Results During AF, dofetilide did not prolong QT (baseline: 368 +/- 48 ms vs. drug: 391 +/- 60, p = NS) whereas during SR, QT was prolonged from 405 +/- 55 to 470 +/- 67 ms (p < 0.01). In four patients (group I), the SR dofetilide infusion was terminated early because QT prolonged to >500 ms, and one patient developed asymptomatic nonsustained TdP. The remaining five patients (group II) received the entire dose during SR. Although deltaQT was greater in group I during SR (91 +/- 22 vs. 45 +/- 25 ms, p < 0.05), plasma dofetilide concentrations during SR were similar in the two groups (2.72 +/- 0.96 vs. 2.77 +/- 0.25 ng/ml), and in AF (2.76 +/- 1.22 ng/ml). DeltaQT in SR correlated inversely with baseline SR heart rate (r = -0.69, p < 0.05), and QT dispersion developing during the infusion (r = 0.79, p < 0.01).Conclusions Shortly after restoration of SR, there was increased sensitivity to QT prolongation by this I(Kr)-specific blocker. Slower heart rates after cardioversion and QT dispersion during treatment appear to be important predictors of this response.

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Monitoring PR, QT, and QRS durations during initiation of antiarrhythmic drug therapy can identify patients at higher risk of drug-induced proarrhythmia on longer-term treatment.
“monitoring PR, QT, and QRS durations during initiation of antiarrhythmic drug therapy can identify patients at higher risk of drug-induced proarrhythmia on longer-term treatment.[669][670][671]”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [671]

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Authors: Choy, A. M. J., Darbar, D., Dell’Orto, S., & Roden, D. M.
Affiliations: Vanderbilt University (US)
Corresponding author: Roden, Dan M
ORCID: Choy, Anna Maria J
Darbar, Dawood
Roden, Dan M
Venue: Journal of the American College of Cardiology
Publisher: Elsevier BV
Published: 1999-08
Volume: 34
Issue: 2
Pages: 396-401
ISSN: 0735-1097 (ISSN-L)
DOI: 10.1016/s0735-1097(99)00226-0
OpenAlex: W2019079248
Cited by: 89
References: 38
Citations by year: 2026: 2 · 2025: 2 · 2024: 1 · 2022: 6 · 2021: 2 · 2020: 1 · 2019: 2 · 2018: 1 · 2017: 3 · 2016: 5 · 2015: 5 · 2014: 3 · 2013: 5 · 2012: 7
FWCI: 1.94
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 5098 d)
Locations: Journal of the American College of Cardiology (publishedVersion)
PubMed (publishedVersion)
Discovery Research Portal (University of Dundee) (acceptedVersion, other-oa)
Funders: Vanderbilt University
University of Dundee
National Institute of General Medical Sciences (GM-07569, T32GM007569)
National Center for Research Resources (RR00095)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
Keywords: QT prolongation, atrial fibrillation, cardioversion, dofetilide, torsades de pointes, sinus rhythm, antiarrhythmic drugs, QT dispersion, heart rate, drug sensitivity
MeSH terms: Anti-Arrhythmia Agents, Atrial Fibrillation, Atrial Flutter, Electric Countershock, Electrocardiography, Female, Heart Rate, Humans, Male, Phenethylamines, Sulfonamides

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Exaggerated QT prolongation after cardioversion of atrial fibrillation

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