Dofetilide

Dofetilide

by AgentX86 - 2024-06-03 21:27:16

Dofetilide  (aka Tikosyn) is next to the top of the heap of antiarrhythmics, right below ameoderone.  It's also in the same position in the toxicity list. I was on Sotolol, with the next step being Tikosyn.  Sotolol damaged my SI node, and got me my very own pacemaker, before I got that far.

The hospitalization is required because of the significant risk of long-QT.  Not that long ago, sotolol had the same restriction but they changed it to out-patient EKG monitoring for the first few days.

To answer your question, no, I haven't been on it.  I have looked into it and probably would have gone there if I didn't have an AV ablation.  I'd give Tikosyn a try if there was no other reasonable choice.  I'd not go to ameoderone for any extended period.

Spending three days in the hospital, when I wasn't sick, didn't sound all that appetizing to me, either.

On it

by godrew - 2024-06-03 22:44:05

Yes I have been on it for 2 years now.  The hospital stay was no problem, thank god because there was no problem.  I did the same hospital stay when I started sotalol about 12 years ago and also when I started varapamil about 18 years ago.  
At least you are being watched while you start a new med, seemed like a good idea to me.  
good luck

A difficult decision

by Gemita - 2024-06-04 04:11:08

SGMFish, there is one member here that I have been in touch with who is doing extremely well on Dofetilide (Tikosyn).   In fact so well, she rarely comes here looking for support any more.  It would be helpful if Godrew could kindly let us know how well Dofetilide suits him and whether his arrhythmia(s) is/are under good control?

I was on both Flecainide (and Digoxin) for several years.  Slowly weaned off both since AFib seemed to worsen after a few years and Flecainide in particular was felt to have become pro arrhythmic.  I am afraid many anti arrhythmic meds have the potential to become pro arrhythmic.  I was offered Amiodarone when Flecainide failed.  Both Amiodarone and Dofetilide are liked by doctors because these meds can clearly work when other meds fail, but of course they are heavy weight meds and come with several health warnings, including pro-arrhythmic potential (Torsades de pointes) with increasing doses (in particular Dofetilide) which is why it is vital to start therapy in hospital where you can be closely monitored to make sure that the dose you receive is safe for you. 

Longer term, I am not sure that there are any “safe” anti arrhythmic meds out there.  A rate control med like a beta blocker or a calcium channel blocker is always a safer option I was told.  Also an ablation is likely to be more effective than anti arrhythmic medication, but of course it is more invasive and may require more than one ablation to stop an arrhythmia like Atrial Fibrillation.

SGMFish, I hope whatever you decide, it is right for you and brings some respite

on it part 2

by godrew - 2024-06-04 08:03:09

It was a seemless transision when I started taking Tikosyn.  I have had a few afib eppisodes that were seen by my EP office remotely, some were a few hours and some were a few minutes.  I did have an ablasion already and they were in there for a long time, longer than originally explained.  The EP says there was tons of scare tissue from my previous myectomy, but no guarentee it works or holds.

While taking tikosyn the doctors will request slighlty more blood test, 3-4 times a year instead of 1-2 times a year.  

I am misserable while in afib and would take almost any drug to keep me out of it.

Thanks

by sgmfish - 2024-06-05 15:21:33

Thanks for the input. Having read your input I feel more confident that Dofetilide is the right next step for me. I've already had 2 ablations (right atrium for flutter, vein isolation in the left atrium). I've also had many cardioversions, but although I feel great afterwards, I go back into afib sooner, and sooner every time (last one done last March, back in afib within a week). I believe much, if not all, of my problems stem from a mitral valve repair done 25 years ago that left scar tissue. They tell me the next step for me is a new pacemaker that can pace both ventricles; so trying this "halfway house" of Dofetilide seems worth the attempt if it works and saves me having another lead installed in my heart.