Flecainide versus ibutilide for immediate cardioversion of atrial fibrillation of recent onset

Reisinger, J.; Gatterer, Edmund; Lang, Wilfried

doi:10.1016/j.accreview.2004.11.033

Cited by 16 publications

(24 citation statements)

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“…A recently published study comparing ibutilide and flecainide found their efficacy to be comparable. 8 As a result of strict exclusion criteria for ibutilide administration no complications were seen in the this group. Patients were observed in a monitor for four hours after administration of ibutilide and then discharged, with no problems reported after discharge.…”

Section: Discussionmentioning

confidence: 80%

Ibutilide for treatment of atrial fibrillation in the emergency department

Viktorsdottir

Henriksdottir²,

Arnar³

2006

Emergency Medicine Journal

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The purpose of this study was to assess the efficacy and safety of ibutilide, a class III antiarrhythmic drug, for acute treatment of atrial fibrillation (AF) in the emergency department (ED) setting. A retrospective analysis was done reviewing all patients with AF who received ibutilide in the ED in a university hospital setting. A total of 22 patients received ibutilide. Another 24 patients who received rate control drugs only served as a control group. Of the 22 patients who received ibutilide, 14 (64%) converted to sinus rhythm. The mean (SD) rate of AF was 137 (24) bpm and the mean QTc interval immediately after conversion to sinus rhythm was 420 (28) ms. There were no complications. In the rate control group 7 patients (29%) converted to sinus rhythm (p<0.05, compared with ibutilide). The mean rate of AF was 126 (26) bpm (p = ns, compared with ibutilide) and the mean QTc interval in those who converted was 377 (28) ms (p<0.05, compared with ibutilide). One patient developed severe bradycardia. Ibutilide is effective for conversion of recent onset AF in patients presenting to the ED and there is a low rate of complications from ibutilide in this setting.

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Section: Discussionmentioning

confidence: 80%

Ibutilide for treatment of atrial fibrillation in the emergency department

Viktorsdottir

Henriksdottir²,

Arnar³

2006

Emergency Medicine Journal

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“…It has similar efficacy to ibutilide39 and greater efficacy than procainamide (92% SR vs 63%)40 and sotalol (52% vs 23%) 41. In comparison with oral flecainide, intravenous flecainide is no more effective for pharmacological cardioversion of recent-onset AF, although intravenous flecainide has a more rapid onset of action (mean time to cardioversion 55 min vs 110 min) 42.…”

Section: Antiarrhythmic Drugs Used For Cardioversion or Prevention Ofmentioning

confidence: 99%

Cardioversion of atrial fibrillation: the use of antiarrhythmic drugs

Schilling

2009

Heart

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Atrial fibrillation (AF) is the commonest atrial arrhythmia and represents a large burden on modern health services. Large multicentre randomised trials have demonstrated that a rhythm control strategy (using antiarrhythmic drugs and direct current (DC) cardioversion) has no morbidity or mortality advantage over rate control. Therefore, for most patients, attempts to cardiovert AF to sinus rhythm (SR) should be reserved for those patients who are symptomatic despite adequate rate control. For recent-onset AF (<24 h) the use of agents like flecainide can be highly successful to pharmacologically cardiovert AF, although caution should be exercised in patients who have the potential for structural or coronary artery disease because of the risk of proarrhythmia. If there any is doubt as to the suitability of a patient for pharmacological cardioversion then DC cardioversion is the safer option. Owing to the high recurrence rate of AF after cardioversion (71-84% at 1 year), the use of antiarrhythmic drugs to maintain SR is recommended. The irreversible side effects of amiodarone mean that it should be avoided whenever possible for long-term maintenance treatment, although it is useful in short courses (8 weeks-6 months), particularly for patients who had a successfully treated secondary cause for AF. Other agents like flecainide and sotalol are also useful but should not be used for patients with structural heart disease. Data supporting the use of newer agents like dronedarone are at present limited.

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“…2 Table 2 shows the various AADs and their efficacy in conversion to sinus rhythm. [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] The studies are heterogeneous in the populations included, doses of drugs used, and the duration of follow-up. The preferred agent for pharmacological cardioversion depends on patient characteristics.…”

Section: Pharmacological Cardioversionmentioning

confidence: 99%

Contemporary Approach to Electrical and Pharmacological Cardioversion of Atrial Fibrillation

Rajagopalan

Curtis

2012

Postgraduate Medicine

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In patients with atrial fibrillation (AF), a rhythm-control strategy may be adopted when there are unacceptable symptoms from AF, failure of rate control, and/or the presence of comorbidities, such as heart failure, that may improve with restoration of sinus rhythm. When a rhythm-control strategy is chosen and the patient is in persistent AF, cardioversion will be necessary to convert the rhythm to sinus. Patients with AF present for > 48 hours must be effectively anticoagulated both prior to and after cardioversion. With newer oral anticoagulants, achieving effective anticoagulation is faster and more reliable, with no requirement for blood test monitoring. Cardioversion can be accomplished either electrically or pharmacologically, and in some cases, electrical cardioversion may be facilitated pharmacologically. Electrical cardioversion has a higher success rate compared with pharmacological cardioversion in the short-term. Pharmacological cardioversion is usually accomplished with intravenous ibutilide, oral flecainide or propafenone, or intravenous amiodarone. Oral amiodarone and dofetilide also result in chemical cardioversion in some patients over a longer period of time. Long-term success in the maintenance of sinus rhythm post-cardioversion can be increased with the use of antiarrhythmic drugs. Alternatively, when AF is recurrent and symptomatic despite the use of antiarrhythmic drugs, catheter ablation is a reasonable option for many patients. Cardioversion may be incorporated into the management approach of persistent AF when the primary therapeutic option chosen is catheter ablation.

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Flecainide versus ibutilide for immediate cardioversion of atrial fibrillation of recent onset

Cited by 16 publications

References 0 publications

Ibutilide for treatment of atrial fibrillation in the emergency department

Ibutilide for treatment of atrial fibrillation in the emergency department

Cardioversion of atrial fibrillation: the use of antiarrhythmic drugs

Contemporary Approach to Electrical and Pharmacological Cardioversion of Atrial Fibrillation

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