New Here — Most Recent Arrhythmia

[wdstk51]

Hi, all — I initially posted this to the Afib Forum but just found this group, which seems more appropriate.

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 had said at the outset 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

[Engineer46]

You are right to have concerns about taking this drug, since you don't appear to have debilitating symptoms of arrhythmia and were finding the Verapamil helpful. However, this is a mainly UK based forum and Dofetilide is not approved for use in the UK nor in the EU, so there will be few here with any personal experience.

Dofetilide was approved for use in the EU in 1999 but, in 2004, Pfizer unilaterally withdrew the authorisation citing "commercial reasons". Perhaps it wasn't being prescribed enough to justify the annual cost of maintaining the approval. As a new drug, it may also have been too expensive for the NHS in the UK to accept since, as you say, it requires a three-day stay in hospital to get the dose adjusted.

After your month of "stress-free" life to see if things settle down, you may want further tests and, if Dofetilide is still being suggested, you may want to seek a second opinion.

I wish you well.

Paul