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(Circulation. 2001;103:1422.)
© 2001 American Heart Association, Inc.

Clinical Investigation and Reports

QTc Interval as a Guide to Select Those Patients With Congestive Heart Failure and Reduced Left Ventricular Systolic Function Who Will Benefit From Antiarrhythmic Treatment With Dofetilide

Bente Brendorp, MD; Hanne Elming, MD, PhD; Li Jun, MD; Lars Køber, MD, DMSc; Marek Malik, MD, PhD, DMSc; Gorm Boje Jensen, MD, DMSc; Christian Torp-Pedersen, MD, DMSc; for the DIAMOND Study Group

From Copenhagen University Hospital, Gentofte (B.B., H.E., L.J., L.K., C.T.-P.), and Copenhagen University Hospital, Hvidovre (G.B.J.), Denmark; and St George’s Hospital Medical School, London, England (M.M.).

Background—A prolonged QTc interval is considered a contraindication for class III antiarrhythmic drugs, but the influence of a normal or a slightly increased baseline QTc interval on the risk or benefit of treatment with a class III antiarrhythmic drug is not sufficiently clarified.

Methods and Results—This prospectively defined substudy included 703 patients enrolled in the Danish Investigations of Arrhythmia and Mortality on Dofetilide-Congestive Heart Failure (DIAMOND-CHF) study. Patients included had moderate to severe CHF and reduced left ventricular systolic function. Baseline QTc interval was measured before randomization to either dofetilide, a new class III antiarrhythmic drug, or placebo. During a median follow-up of 18 months (minimum 1 year), 285 patients (41%) died. Baseline QTc interval had no prognostic value on survival in placebo-treated patients. In dofetilide-treated patients, a baseline QTc interval <429 ms was associated with a significant risk reduction (risk ratio 0.4, 95% CI 0.3 to 0.8). With increasing QTc interval, the risk increased gradually, and for QTc interval >479 ms, risk ratio was 1.3 (0.8 to 1.9).

Conclusions—A baseline QTc interval within normal limits is associated with a marked reduction of mortality in patients with CHF and left ventricular systolic dysfunction treated with dofetilide. This is a potentially important indication of which patients with CHF might benefit from prophylactic treatment with an antiarrhythmic drug.

Key Words: heart failure • prognosis • antiarrhythmia agents

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