Dofetilide Reduces Morbidity, but Not Mortality, in CHF Patients

	September 16, 1999 - Dofetilide, a new class 3 anti-arrhythmic drug,
reduces hospitalizations and a-fib (atrial fibrillation) in CHF patients with
no effect on mortality, according to a report in the September 16 issue of
The New England Journal of Medicine.
	Dr. Christian Torp-Pedersen compared the rates of a-fib,
hospitalization, and death in 762 patients treated with dofetilide and 756
patients who received placebo. Mortality did not differ between the 2 groups.
In the dofetilide group, 41% died during the 3 year study, compared to 42% in
the placebo group.
	On the other hand, compared with the placebo group, the dofetilide
patients "had a lower rate of hospitalization for worsening heart failure
(30% vs 38%) and a lower incidence of hospitalizations for worsening heart
failure (352 events vs 422 events)."
	Dofetilide-treated patients with a-fib were more likely to convert to
normal sinus rhythm, and to maintain that normal rhythm, than those receiving
placebo. Except for their tendency to develop prolonged corrected QT intervals
and torsade de pointes, patients treated with dofetilide experienced no more
adverse events than patients given placebo.
	"If started in the hospital with continuous heart monitoring,
dofetilide can be used to treat CHF patients with a-fib," Dr. Torp-Pedersen's
group writes.
	"Although both dofetilide and amiodarone prevent development of a-fib
in CHF patients, routine preventive therapy with anti-arrhythmic drugs is
currently not warranted," Drs. William Stevenson and Lynne Stevenson say in a
related editorial. "For certain select patients," said Dr. Stevenson,
"dofetilide treatment would be reasonable, so long as you take all the
precautions taken in this study." "Most heart failure patients with
persistent a-fib, though, should be treated with anti-coagulation and drugs
that control the overall heart rate," he added.

N Engl J Med 1999;341:857-865, 910-911