Torsade de pointes: the clinical considerations

Gowda, Ramesh M.; Khan, Ijaz A.; Wilbur, Sabrina L.; Vasavada, Balendu C.; Sacchi, Terrence J.

doi:10.1016/j.ijcard.2003.04.055

Cited by 82 publications

(51 citation statements)

References 52 publications

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“…The most common and the most serious of these arrhythmias is torsade de pointes, which is a distinct, polymorphic, ventricular tachycardia occurring in the setting of a prolonged QT interval. 49,50 The predictors of occurrence of torsades de pointes in patients treated with ibutilide are bradycardia, small body size, history of heart failure, nonwhite race, and female sex. 50 Most episodes of torsade de pointes occur during the first hour of treatment with ibutilide.…”

Section: Adverse Effects Of Ibutilidementioning

confidence: 99%

“…49,50 The predictors of occurrence of torsades de pointes in patients treated with ibutilide are bradycardia, small body size, history of heart failure, nonwhite race, and female sex. 50 Most episodes of torsade de pointes occur during the first hour of treatment with ibutilide. The half-life of ibutilide is 3 to 6 hours; its clinical effect can be measured by the corrected QT interval, which disappears in 2 to 6 hours.…”

Section: Adverse Effects Of Ibutilidementioning

confidence: 99%

“…50 The risk of developing torsade de pointes with ibutilide monotherapy is 4%. 52 However, the risk is reduced to 1% in patients who are already taking propafenone or flecainide.…”

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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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%

See 1 more Smart Citation

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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“…Apart from drugs and electrolyte imbalance, there are other comorbid conditions, such as uncontrolled diabetes mellitus and probably myocardial ischemia, which can lead to TdP (3,(6)(7)(8). TdP episodes produce syncope or pseudoseizure secondary to an abrupt reduction in cerebral blood flow.…”

Section: Discussionmentioning

confidence: 99%

Torsade de Pointes with Presentation of Seizure in the Ischemic Heart Disease Context: A Case Report

et al. 2017

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Introduction: Torsade de pointes (TdP) is a devastating form of ventricular arrhythmia, mainly associated with prolongation of corrected QT (QTc) interval. In general, a TdP episode terminates spontaneously, produces syncopal episodes, or degenerates lethal arrhythmias. There are few reports on TdP in the context of ischemic heart disease (IHD). The present report describes a case of TdP in an IHD patient with presentation of seizure. Case Presentation: We describe the case of a 64-year-old man with a history of diabetes, complaint of chest discomfort, and diagnosis of unstable angina. The patient experienced recurrent myoclonic jerks, as well as transient, but progressive changes in consciousness; however, they were related to cardiac arrhythmia rather than a brain disorder. Conclusions: Cardiac arrhythmias, similar to TdP episodes, should be taken into consideration in the management of IHD patients with seizure.

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“…While many episodes may be self terminating, torsade can degenerate into lethal ventricular fibrillation [11]. In nonuremic patients, episodes of torsade de pointes often occur due to a combination of factors, including prolonged QTc with bradycardia, pauses, some medications or electrolyte abnormalities such as hypokalemia, hypomagnesemia or hypocalcemia.…”

Section: Introductionmentioning

confidence: 99%

Parameters of Cardiac Electrical Instability in Chronic Haemodialysis Patients

Abdel-Galeel¹

2015

AJIM

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Torsade de pointes: the clinical considerations

Cited by 82 publications

References 52 publications

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

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

Torsade de Pointes with Presentation of Seizure in the Ischemic Heart Disease Context: A Case Report

Parameters of Cardiac Electrical Instability in Chronic Haemodialysis Patients

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