Dofetilide/magnesium
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Lack of efficacy: case report A 40-year-old man exhibited lack of efficacy during treatment with dofetilide and magnesium to reduce the risk of Torsades de pointes [dosages and routes not stated]. The man had a history of unrepaired Tetralogy of Fallot (TOF) with pulmonary atresia and multiple aortopulmonary collaterals, which resulted in Eisenmenger syndrome and pulmonary hypertension. He presented with hypoxic respiratory failure in the setting of heart failure exacerbation. A transthoracic echocardiogram showed classic features of unrepaired TOF and generalised left ventricular hypokinesis with a left ventricular ejection fraction of 25%. Laboratory test showed a significant result for iron deficiency anaemia and secondary polycythaemia. He was treated with unspecified beta blockers, diuretics and heparin drip for a new onset of atrial fibrillation. additionally, he was receiving treatment with bosentan and tadalafil concomitantly. He underwent transesophageal echo-cardiogram guided cardioversion and converted into 2:1 atrial flutter. After cardioversion, he reverted back to atrial fibrillation. His diuresis was then increased, which led to a spontaneous conversion to normal sinus rhythm. For reduction of the risk of Torsades de pointes, he started receiving dofetilide and magnesium, but he continued to show prolonged QTc interval. The man’s therapy with dofetilide was discontinued and treatment with metoprolol was initiated. His discharge medications included metoprolol, lisinopril, torasemide and dabigatran etexilate [pradaxa]. His treatment with bosentan and tadalafil was continued. Sharma T, et al. Cyanotic congenital heart disease in adulthood. American Journal of Respiratory and Critical Care Medicine 199: (plus poster) abstr. A1928, No. 9, May 803447272 2019. Available from: URL: https://doi.org/10.1164/ajrccm-conference.2019.199.1_MeetingAbstracts.A1928 [abstract]
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Reactions 18 Jan 2020 No. 1787
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