Safety and Risk/Benefit Analysis of Ibutilide for Acute Conversion of Atrial Fibrillation/Flutter

Kowey, Peter R.; VanderLugt, James T.; Luderer, John R.

doi:10.1016/s0002-9149(96)00566-8

Cited by 124 publications

(84 citation statements)

References 10 publications

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“…Hence, a minimum of a 4-to 6-hour observation period is recommended after ibutilide treatment. 8,9 The rate of administration may also be important because faster rates of administration of class III agents have been shown in experimental models to increase the risk of torsade de pointes. 51 The risk is increased in patients with severe left ventricular systolic dysfunction with an ejection fraction Ͻ20%.…”

Section: Adverse Effects Of Ibutilidementioning

confidence: 99%

“…8 This rate is decreased by the infusion of intravenous magnesium before ibutilide administration. In view of the risk of ventricular arrhythmias, patients should be monitored in an intensive care unit during and for at least 4 hours after ibutilide infusion.…”

Section: Adverse Effects Of Ibutilidementioning

confidence: 99%

“…The degree of prolongation of QT interval is related to the dose, the rate of infusion, and serum concentration. 7 The QT interval returns to baseline within 2 to 4 hours after stopping the infusion 8,9 ; however, PR or QRS intervals are not affected.…”

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confidence: 99%

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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

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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.

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Section: Adverse Effects Of Ibutilidementioning

confidence: 99%

Section: Adverse Effects Of Ibutilidementioning

confidence: 99%

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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

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“…The half-life is 2 to 12 h (mean 6 h). [20][21][22][23][24][25] Among the class III and class I antiarrhythmic agents, ibutilide is one of the most effective agents for cardioversion, and most of the patients convert to sinus rhythm within 1 h of initiation of therapy. [27][28][29][30] All patients should be monitored closely for 4 h, as there is a 2 to 3% risk of torsade de pointes and occasional hypotension.…”

Section: Discussionmentioning

confidence: 99%

“…14,15 Among the pharmacologic methods available, ibutilide, a class III antiarrhythmic agent, has been shown to be effective in the acute treatment of AF. [16][17][18][19][20][21] The spontaneous conversion rate in new onset AF within the first 24 h is as high as 50-70% with highest incidence in the first 8 h, and it drops to < 8 % after 24 h. Therefore, only half of the patients with new onset AF will require cardioversion if monitored for > 24 h. It has also been shown to be cost effective when the patients are treated with direct current (DC) cardioversion. 22 We evaluated the response rate of ibutilide in AF of > 24 h duration to minimize the chance of spontaneous conversion.…”

Section: Introductionmentioning

confidence: 99%

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

Das

Cheriparambil

Bedi

et al. 2002

Clinical Cardiology

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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-

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