In a patient with heart failure and reduced ejection fraction who has experienced SVT, which drug is most appropriate for preventing recurrence?

In a patient with heart failure and reduced ejection fraction who has experienced supraventricular tachycardia (SVT), dofetilide serves as the most appropriate choice for the prevention of recurrence. Dofetilide is a Class III antiarrhythmic agent that works by blocking potassium channels, which prolongs the action potential and refractoriness, effectively helping to restore normal sinus rhythm in patients with atrial fibrillation or other forms of SVT.

Dofetilide has demonstrated efficacy in patients with heart failure and can be used safely in those with reduced ejection fraction, provided renal function is monitored, as dosing adjustments may be necessary based on (renal clearance. Its ability to maintain ventricular rate control and promote sinus rhythm makes it a preferred option in this context.

In contrast, other options may pose higher risks or are less suitable for heart failure patients. For example, diltiazem, while effective for rate control, is a calcium channel blocker that may not be the ideal choice for heart failure with reduced ejection fraction due to negative inotropic effects. Flecainide and propafenone, both Class IC antiarrhythmics, are contraindicated in patients with structural heart disease, including those with heart