Acute conversion of persistent XXXX during dofetilide loading does not predict long-term @entity955 -free survival.

@entity1 @entity943 @entity955
PURPOSE: Pharmacologic conversion of @entity955 and flutter (AF/AFl) is common with dofetilide. We determined whether pharmacologic conversion with dofetilide predicts long-term @entity943 -free survival. METHODS: We retrospectively studied a cohort of 264 consecutive @entity1 who initiated dofetilide during persistent AF/AFl between 2008 and 2013. @entity1 were excluded if dofetilide was discontinued prior to five doses or electrical cardioversion was performed prior to four doses. Incidence of and characteristics associated with pharmacologic conversion were determined. @entity1 were followed for long-term AF/AFl recurrence. Predictors of recurrence were identified using multivariate Cox modeling. RESULTS: Of 205 @entity1 meeting study criteria, 92 (44.9  %) converted to sinus rhythm during dofetilide loading. Female gender, history of AFl, greater number of prior catheter ablations, shorter duration of current AF/AFl, and presentation in AFl were all associated with acute pharmacologic conversion (p   =   0.001, 0.05, 0.001, 0.003, and 0.003, respectively). In multivariate modeling, longer time since first AF/AFl diagnosis (hazard ratio (HR)   =   1.07 per 1-year increase, 95  % confidence interval (CI) 1.03-1.10, p   <   0.001), longer duration of current AF/AFl episode (HR   =   1.01 per 1-month increase, 95  % CI 1.00-1.01, p   =   0.003) and greater number of failed antiarrhythmic drugs (HR   =   1.43 per one drug increase, 95  % CI 1.20-1.70, p   <   0.001) were independently associated with shorter time to AF/AFl recurrence. Pharmacologic conversion was not significantly associated with time to AF/AFl recurrence (HR   =   0.79, 95  % CI 0.57-1.10, p   =   0.2). CONCLUSIONS: Acute pharmacologic conversion of persistent AF/AFl to sinus rhythm frequently occurs during dofetilide loading. Nevertheless, acute pharmacologic conversion does not predict long-term @entity943 control, which was moderate at best.
