Efficacy and safety of dofetilide and sotalol in patients with hypertrophic cardiomyopathy

Background Professional society practice guidelines conflict regarding their recommendations of dofetilide (DOF) and sotalol (STL) for treatment of arrhythmias in hypertrophic cardiomyopathy (HCM), and supporting data is sparse. We aim to assess safety and efficacy of DOF and STL on arrhythmias in HCM. Methods This was an observational study of HCM patients treated with DOF or STL for atrial fibrillation (AF) and ventricular arrhythmias (VA). Outcomes of drug discontinuation and arrhythmia recurrence were compared at 1 year and latest follow-up by Kaplan–Meier analysis. Predictors of drug failure were studied using uni- and multi-variable analyses. Drug-related adverse events were quantitated. Results Here we show that of our cohort of 72 patients (54 ± 14 years old, 75% male), 21 were prescribed DOF for AF, 52 STL for AF, and 18 STL for VA. At 1 year, discontinuation and recurrence rates were similar for DOF-AF (38% and 43%) and STL-AF (29% and 44%) groups. Efficacy data was similar at long-term follow-up of 1603 (IQR 994–4131) days, and for STL-VA. Drug inefficacy was the most common reason for discontinuation (28%) followed by side-effects (13%). Incidences of heart failure hospitalization (5%) and mortality (3%) were low. One STL-AF patient developed non-sustained torsades de pointes in the setting of severe pneumonia and acute kidney injury, but there were no other drug-related serious adverse events. Conclusions DOF and STL demonstrate modest efficacy and satisfactory safety when used for AF and VA in HCM patients. Plain language summary Hypertrophic cardiomyopathy (HCM) is a genetic condition that affects the heart muscle by making it abnormally thick. It often also causes abnormalities in the heartbeat, known as arrhythmias, which can cause symptoms such as dizziness and shortness of breath, or death. Historically it has been advised that some drugs that can affect the heartbeat should not be used in those with HCM, leaving people with HCM to be treated with other drugs that have undesirable side effects. We studied HCM patients who had been prescribed two of the drugs that were advised not to be used, called dofetilide and sotalol. The drugs were found to have been safe and effective over a 4-year period. These results suggest that clinical guidelines should be updated to support the use of these drugs for the treatment of arrhythmias in patients with HCM. Chen et al. compare effectiveness and adverse events in hypertrophic cardiomyopathy patients