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Adult-onset Still disease — ABIM Board MCQ

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HardRheumatology/Allergy/ImmunologyAdult-onset Still diseaseABIM Board

A 66-year-old with symptomatic atrial fibrillation and HFrEF is considering dofetilide after shared decision-making. Which safety arrangement is required when the drug is initiated?

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Correct answer: C — Admit for continuous ECG and renal-dose monitoring

Dofetilide initiation or reloading requires inpatient monitoring because early QT prolongation and torsades can occur. Dosing depends on creatinine clearance, and continuous ECG monitoring is part of the safe initiation protocol.

Reference: 2023 ACC/AHA/ACCP/HRS Atrial Fibrillation Guideline: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193?url_ver=Z39.88-2003