Efficacy and Safety of Ibutilide Fumarate for the Conversion of Atrial Arrhythmias After Cardiac Surgery

VanderLugt, James T.; Mattioni, Thomas A.; Denker, Stephen; Torchiana, David F.; Ahern, Thomas; Wakefield, Linda K.; Perry, Kimberly T.; Kowey, Peter R.

doi:10.1161/01.cir.100.4.369

Cited by 140 publications

(73 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The efficacy of combined therapy appears to be similar to that of previously published reports of cardioversion with ibutilide alone. [7][8][9][10][11] There was 1 episode of nonsustained torsade de pointes. This was the only proarrhythmic event observed despite marked further prolongation of the QT interval after combination therapy.…”

Section: Discussionmentioning

confidence: 99%

Chemical Cardioversion of Atrial Fibrillation or Flutter With Ibutilide in Patients Receiving Amiodarone Therapy

et al. 2001

View full text Add to dashboard Cite

Background-Ibutilide is a class III drug that is used for the cardioversion of atrial arrhythmias, but it can cause torsade de pointes. Amiodarone also prolongs the QT interval but rarely causes torsade de pointes. There are no studies in which the concomitant use of the 2 agents was examined. The purpose of the present study was to assess the efficacy and safety of cardioversion with combination therapy in patients with atrial fibrillation or flutter. Methods and Results-The study included 70 patients who were treated with long-term oral amiodarone and were referred for elective cardioversion of atrial fibrillation (57 of 70, 81%) or flutter (13 of 70, 19%). Patients were taking amiodarone (153Ϯ259 days, meanϮSD) and were administered 2 mg intravenous ibutilide. Left ventricular ejection fraction was measured with echocardiography. The QT intervals were measured on 12-lead ECG. Fifty-five patients (79%) had structural heart disease. Patients were in arrhythmia for 196Ϯ508 days before cardioversion, with a left ventricular ejection fraction of 50Ϯ11%. In patients with atrial fibrillation, 22 (39%) of 57 and 7 (54%) of 13 patients with flutter converted within 30 minutes of infusion. Thirty-nine patients who did not convert after ibutilide were treated with electrical cardioversion, and 35 (90%) of 39 patients were successfully converted. The QT intervals were further prolonged after ibutilide for the group from 371Ϯ61 to 479Ϯ92 ms (PϽ0.001). There was 1 episode of nonsustained torsade de pointes (1 of 70, 1.4%) after ibutilide. Conclusions-The use of ibutilide converted 54% of patients with atrial flutter and 39% of patients with atrial fibrillation who were treated with long-term amiodarone. Despite QT-interval prolongation after ibutilide, only 1 episode of torsade de pointes occurred. Our observations suggest that combination therapy may be a useful cardioversion method for chronic atrial fibrillation or flutter.

show abstract

Section: Discussionmentioning

confidence: 99%

Chemical Cardioversion of Atrial Fibrillation or Flutter With Ibutilide in Patients Receiving Amiodarone Therapy

et al. 2001

View full text Add to dashboard Cite

show abstract

“…The time to conversion also decreased with increasing doses of ibutilide. 19 The conversion rates were higher in all doses for atrial flutter compared with atrial fibrillation. Ibutilide's efficacy and safety profile was compared with those of amiodarone and propafenone in terminating postoperative atrial fibrillation 20,21 (Table 1).…”

Section: Use Of Ibutilide In Postoperative Atrial Fibrillation and Flmentioning

confidence: 91%

Safety and Efficacy of Ibutilide in Cardioversion of Atrial Flutter and Fibrillation

Nair¹,

George²,

Koshy

2011

The Journal of the American Board of Family Medicine

View full text Add to dashboard Cite

This article reviews the safety and efficacy of ibutilide for use in patients with atrial fibrillation and flutter. Ibutilide, a class III antiarrhythmic agent, is primarily used for conversion of atrial flutter and fibrillation and is a good alternative to electrical cardioversion. Ibutilide has a conversion rate of up to 75% to 80% in recent-onset atrial fibrillation and flutter; the conversion rate is higher for atrial flutter than for atrial fibrillation. It is also safe in the conversion of chronic atrial fibrillation/flutter among patients receiving oral amiodarone therapy. Ibutilide pretreatment facilitates transthoracic defibrillation and decreases the energy requirement of electrical cardioversion by both monophasic and biphasic shocks. Pretreatment with ibutilide before electrical defibrillation has a conversion rate of 100% compared with 72% with no pretreatment. Ibutilide is also safe and efficient in the treatment of atrial fibrillation in patients who have had cardiac surgery, and in accessory pathway-mediated atrial fibrillation where the conversion rate of ibutilide is as high as 95%. There is up to a 4% risk of torsade de pointes and a 4.9% risk of monomorphic ventricular tachycardia. Hence, close monitoring in an intensive care unit setting is warranted during and at least for 4 hours after drug infusion. The anticoagulation strategy is the same as for any other mode of cardioversion. In selected patient populations, cardioversion still remains the preferred management for atrial fibrillation and flutter, even though data suggest no survival advantage for rhythm control over rate control.1 Electrical cardioversion has been the most widely used and the most effective method to restore sinus rhythm in these atrial arrhythmias. However, chemical cardioversion is a good alternative for use in certain patient groups. Chemical cardioversion is less invasive, more cost-effective, and, unlike electrical cardioversion, it does not require sedation. Ibutilide-despite its efficacy, which is comparable or superior to other agents-is not widely used, mainly because of physician's lack of awareness about its safety and efficacy profile. This article reviews the safety and efficacy data of ibutilide and also compares it with other antiarrhythmics used for atrial fibrillation and flutter.Ibutilide, a class III antiarrhythmic drug that was approved by the Food and Drug Administration for This article was externally peer reviewed.

show abstract

“…37 This is because the etiology of CHF is multifactorial and the response rate in the presence of CHF varies according to the prevalence of negative predictors such as MVD or positive predictor such as CAD in the population studied. It may possibly be due to a smaller number of patients with CAD (patients post coronary artery bypass graft [CABG]) in our study group.…”

Section: Discussionmentioning

confidence: 99%

Cardioversion of atrial fibrillation with ibutilide: When is it most effective?

Das

Cheriparambil

Bedi

et al. 2002

Clinical Cardiology

View full text Add to dashboard Cite

SummaryBackground: Atrial fibrillation (AF) is found in 1% of persons above the age of 60 years. More than 5% of the population older than 69 years and about 14% of octogenarians are at risk for this arrhythmia. It is estimated that 1.5 to 3 million persons in the United States alone suffer from AF. The public health implications and attendant morbidity are a significant drain on our health care system.Hypothesis: The purpose of this study was to determine the clinical and echocardiographic predictors of success in converting AF of ≥ 24 h duration.Methods: Demographic and clinical and echocardiographic parameters of 101 patients with recent onset AF (> 24 h) who received ibutilide were studied.Results: Of 101 patients, 56 (55%) converted to sinus rhythm. Age, gender, hypertension, diabetes mellitus, left ventricular ejection fraction (≤ 35%), congestive heart failure, and previous medication for rate control had no significant effect on the conversion rate. Conversion rate was only 30% (9/30 patients) in the presence of an enlarged left atrium (LA ≥ 5 cm) and 37.7% (23/61 patients) in the presence of mitral valve disease (MVD), whereas the conversion rate was 82.5% (33/40 patients) in the absence of MVD and 85% (29/34 patients) in the absence of both enlarged LA and MVD (p = < 0.001). Patients with coronary artery disease (CAD) also exhibited a significantly greater response to ibutilide than patients without CAD (77 vs. 46%, p-value 0.005).Conclusion: As a therapy for cardioversion of AF, ibutilide is most effective in a selected subgroup patients, such as in pa-

show abstract

Efficacy and Safety of Ibutilide Fumarate for the Conversion of Atrial Arrhythmias After Cardiac Surgery

Abstract: Ibutilide is a useful and safe treatment alternative for the atrial arrhythmias that occur after cardiac surgery.

Cited by 140 publications

References 31 publications

Chemical Cardioversion of Atrial Fibrillation or Flutter With Ibutilide in Patients Receiving Amiodarone Therapy

Chemical Cardioversion of Atrial Fibrillation or Flutter With Ibutilide in Patients Receiving Amiodarone Therapy

Safety and Efficacy of Ibutilide in Cardioversion of Atrial Flutter and Fibrillation

Cardioversion of atrial fibrillation with ibutilide: When is it most effective?

Contact Info

Product

Resources

About