Abstract 18489: Predictors of Successful Chemical Cardioversion With Dofetilide in Patients With Persistent Atrial Fibrillation

Abstract

Introduction: Dofetilide induced cardioversion in persistent atrial fibrillation (AF) patients is not well described. We intended to evaluate the incidence and predictors of chemical cardioversion after initiation of Dofetilide in patients with persistent AF. Methods: We performed a retrospective study including all patients with persistent AF who were admitted for initiation of Dofetilide in our center. Patients in sinus rhythm (SR) at the time of initiation were excluded. All patients were in the hospital for a minimum of 5 doses of the drug. If patients did not convert to SR spontaneously on the drug by the 4 th dose, they underwent electrical cardioversion (DCCV). Results: Of the 305 patients who underwent dofetilide initiation at our center, 195 (64%) persistent AF patients were in AF at the time of the first dose. Mean age of the population was 65 ±9 years with 61 (31%) females. Mean CHADS2 score was 1.7 ±1.0. Median duration of AF was 36 (IQ 12-84) months with a mean LA diameter of 4.6±0.8cm. Mean number of prior failed antiarrhythmic drugs (AAD) was 1.4 ±1.1. Spontaneous conversion to SR occurred in 91 (47%) patients. Patients who converted to SR were much more likely to be females (40% vs 24%; p = 0.020) and had smaller left atrial diameter (4.4 vs 4.7cm; p = 0.023). In multivariate analysis including age, gender, duration of AF, number of prior AADs, LA diameter, heart failure and LVED, the only independent predictor of successful chemical cardioversion was female gender (OR: 2.4; p = 0.022). Conclusion: In patients with persistent AF, female gender is independently associated with successful chemical cardioversion with dofetilide.