Initiation and Monitoring of Class III Antiarrhythmic Agents

Dofetilide is a Class III antiarrhythmic agent that is approved by the United States Food and Drug Administration (FDA) for use in the conversion of atrial fibrillation, as well as in the maintenance of normal sinus rhythm. Because of the risk of torsades de pointes associated with dofetilide, the FDA mandated in-hospital initiation of therapy and initially restricted dofetilide's availability to institutions and prescribers who completed appropriate educational forums. The use of dofetilide within health care systems requires specific procedures for prescribing, dispensing, and monitoring, as well as a format for educating personnel who will be involved in the care of these patients. Several models have demonstrated success in initiating dofetilide and are also used for sotalol, which also can cause torsades de pointes. The utilization of nonphysician personnel, such as nurse practitioners and clinical pharmacists, in conjunction with a team approach were essential components for the success of these models. Preprinted order forms or procedural guidelines, as well as computer-assisted dosing programs, can be utilized to prevent inappropriate or miscalculated dosing of these agents, which potentially can cause life-threatening ventricular arrhythmias. (J Cardiovasc Electrophysiol, Vol. 14, pp. S291-S295, December 2003, Suppl.)