Dofitilide without Afib??

[wdstk51]

Hi, all — not sure this is the right place to be, since it doesn’t really appear that I have AFib. I was experiencing episodes of tachycardia sometimes lasting up to a half hour or so. Being a non-cardiologist, my first thought was Afib and, indeed, that’s what my Apple Watch said. I ended up going to see my electrophysiologist, who had me on Verapamil for frequent APCs and occasional PVCs. It seemed to be working pretty well. They gave me an event monitor to wear for three weeks and the results (bear with me) were:

CONCLUSION: Abnormal 21 day event monitor recording, showing sinus rhythm in the 50s and 60s with frequent APCs and frequent brief runs of non sustained atrial tachycardia. Longest run lasted 10 seconds, was poorly organized and had a rate of 135 bpm. Atrial fibrillation was not documented. There were occasional PVCs, one 5 beat run of non sustained ventricular tachycardia. There were several brief runs of non sustained accelerated idioventricular rhythm at a rate of 75 bpm. One such run lasted 22 seconds and was not associated with symptoms.

So….here’s my dilemma. I’m in the US and the doc suggested I switch to Dofitilide, with the whole 3 day stay at the hospital and other associated risks. I didn’t really understand what was involved until I got home and read up. To me, it appears Dofitilide (Class III Antiarrhythmic) is like bringing a cannon to a knife fight. It appears to be used mostly by folks with fairly intractable Afib.

Also, the three weeks I was wearing the monitor were a month after a total hip replacement, during which I was in pain and stressed, I’d had COVID during the summer and I got a COVID vaccine the day before I put on the monitor. THinking that might have played into the wonky rhythm stuff. Well, now I’m scared and confused. I wrote to the doc through the patient portal and proposed waiting a month before making any decisions, to see if symptoms abated. He said not to be concerned about the test results, but if that’s the case, I’m wondering why such a heavy duty drug?

Thanks for allowing me to vent. I’d be interested in hearing from anyone with any insights. BTW, 71 yr old woman, otherwise healthy, with 2 bionic hips.

[BobD Volunteer]

This drug is not licensed here in UK or Europe so I can't offere any advice . I think you already know your way forward.

[CDreamer]

I tend to agree with your analysis, think I would do the same thing in your shoes.

[SeanJax]

It is a tough medical case to deal with. Your event monitor over 21 days showed a mixture of two level of arrythmias, supraventricular (atrium), and ventricular although it is not sustained fortunately. And they lasted only less than 22 seconds at most. And your episodes your said might last up to half hour. And no signs of afib during these 21 days. It does not mean you did not have Afib. Instead of answering directly your question, I would ask the ep what is the underlying cause of these arrythmias. A second opinion would be recommended. If I were you I would buy a single lead Kardia and recorded all episodes and documented all of them. And I would ask you the question if the episodes become sustained, how would you know it is ventricular tachycardia or not?. idioventricular rhythm is a slow pace of ventricular tachycardia. If it is and it is sustained, it requires immediately hospitalization in cardiac ICU. You see the dilemma here because you are not going to go the ER for each episode of tachycardia.

Now to answer your question Tikosyn or not, if it were me, I would accept it if and only if the episodes are becoming sustained especially ventricular tachycardia. Everybody does have short burst of SVT or atrial tachycardia or pac or pvc BUT not ventricular tachycardia. Your ep suggested Tikosyn probably because of your VT and it is prescribed as off label for VT. It is my educated guess. Hope it helps.

[sillguy]

I have been on Tikosyn for 7 years with no ill effects that I know of so far. The 3 days in hospital for initial administration were no big deal and they actually wanted to shorten that once all was going well with the EKGs they were frequently checking (I discouraged the shortened stay; in the end we compromised). Best of luck in your quest for answers, it seems there are very few in any aspect of AFib or its cousins.

[Nigel2000]

I’ ve been on dofetilide since 2019. I see, to have quite recalcitrant AFIB as it only slightly (though significantly) diminished my afib. After 2 ablations, I’m out of afib but still on dofetilide. When I’ve tried to stop the dofetilide, I get lots of ectopics and short runs of afib. The only 2 negative side effects are 1) I blame it for my weight gain and 2) I worry about long term effects. If I had ventricular tachycardia and my doc suggested it, I would take it.