Use of ibutilide for cardioversion of recent-onset atrial fibrillation and flutter in elderly

Ibutilide is a class III antiarrhythmic drug used for pharmacological cardioversion of recent-onset atrial fibrillation and flutter. The objective of the study was to assess the efficacy of ibutilide in elderly patients (age, >or=65 years). The study population consisted of 32 consecutive elderly patients (17 women, 15 men; mean age, 76 +/- 8 years; age range, 65-94 years) with recent-onset atrial fibrillation (19 patients) or flutter (13 patients). Ibutilide was administered 1-mg intravenously over 10 minutes, and a second 10-minute infusion of 1-mg was given if the arrhythmia did not terminate within 10 minutes after the end of initial infusion. Twenty-six patients received two 1-mg doses of ibutilide. The rate of successful arrhythmia termination was 59% (19 patients): 63% in patients with atrial fibrillation (12 of 19) and 54% in atrial flutter (7 of 12). The mean conversion time was 33 +/- 45 minutes. Three-fourths of the conversions occurred within 45 minutes of treatment. No clinical variables were correlated with success of cardioversion. Patients with a left atrial size of 50 mm or larger had a conversion rate of 50% compared with a conversion rate of 61% in patients with a left atrial size of less than 50 mm (P = NS). Ibutilide-induced lengthening in the QTc interval was of 17 +/- 21 milliseconds. Cardiac complications were torsade de pointes (1 patient), nonsustained ventricular tachycardia (1 patient), and transient bradycardia (1 patient). Torsade de pointes was terminated with direct current cardioversion. Ibutilide appears to be an effective drug for conversion of recent-onset atrial fibrillation and flutter in elderly patients under monitored conditions. Complications are rare and transient.     

伊布利特转复心房颤动及心房颤动前后脑钠肽和心功能的变化

目的观察新型Ⅲ类抗心律失常药物伊布利特转复心房颤动的有效性与安全性及治疗前后脑钠肽浓度和心功能的变化。方法选择心房颤动患者98例,随机分成伊布利特组(n=47)和胺碘酮组(n=51),观察两组的转复率及不良反应,测定98例心房颤动患者转复前后氨基末端脑钠肽前体(NT-BNP)浓度、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左室射血分数(LVEF)的变化。结果两组转复后NT-BNP水平明显降低(P<0.05)。转复后LVEDV、LVEF增加,与转复前比较均差异有统计学意义。转复后LVESV无明显变化。伊布利特组转复心房颤动的成功率高于胺碘酮组(70.21%vs 52.94%,P<0.05),发作的持续时间低于24 h的心房颤动转复率(77.7%)明显高于持续时间高于24 h者(60%);伊布利特最严重的不良反应为非持续性单形室性心动过速,发生率为12.77%。结论伊布利特对心房颤动患者是一种安全有效的转复药物。     

依布利特转复脑栓塞并心房纤颤的临床研究

目的评价新型Ⅲ类抗心律失常药物依布利特转复脑栓塞并心房纤颤（房颤）患者的有效性和安全性。方法本研究选择脑栓塞并房颤持续1h-90d的患者40例,其中男24例,女16例,10min内静脉注射依布利特1mg,如给药结束10min后仍未转复为窦性心律,重复前述治疗1次。观察开始给药后90min内房颤的转复率及4h内的不良反应。结果①依布利特转复脑栓塞房颤的成功率高（77．5％,31／40）;②脑栓塞房颤的转复率与房颤的持续时间有关,持续时间低于24h的房颤转复率（89．29％,25／28）明显高于持续时间超过24h者（50％,6／12,P〈0．05）;③脑栓塞房颤的转复率与左心房直径呈负相关,左心房直径〈4．0cm患者的转复率（92％,23／25）明显高于左心房直径≥4．0cm患者的转复率（53．33％,8／15,P〈0．05）;④脑栓塞房颤的转复率与脑栓塞严重程度和基础疾病有关;⑤依布利特的不良反应：消化道症状,1例出现恶心（2．5％,1／40）,1例发生非持续性单形室性心动过速,发生率为（2．5％,1／40）,均未经特殊处理很快消失,未发现有低血压及长间歇。结论依布利特是一种转复房颤的抗心律失常药物,能有效、快速、安全的转复脑栓塞患者的心房纤颤。     

The safety and efficacy of ibutilide in children and in patients with congenital heart disease

BACKGROUND: The safety and efficacy of ibutilide in the cardioversion of atrial flutter and atrial fibrillation in children and in patients with congenital heart disease (CHD) is unknown. METHODS: Data from 19 patients (age 6 months to 34 years, median 16 years) who received ibutilide for atrial flutter or atrial fibrillation between 1996 and 2005 was retrospectively reviewed. There were 15 patients with CHD (14 had prior heart surgery); four children had normal heart structure. RESULTS: There were 74 episodes of atrial flutter and four episodes of atrial fibrillation (median episodes per patient was one, range 1-31). Ibutilide converted 55 of all the episodes (71%). Ibutilide was successful during its first-ever administration in 12 of 19 patients (63%). Fourteen episodes in six patients required electrical cardioversion after ibutilide failed. There were no episodes of symptomatic bradycardia. One patient went into torsade de pointes and one patient had nonsustained ventricular tachycardia. CONCLUSION: With careful monitoring, ibutilide can be an effective tool in selected patients for cardioversion of atrial flutter.     

Termination of recent-onset atrial fibrillation/flutter in the emergency department: a sequential approach with intravenous ibutilide and external electrical cardioversion

Safety and effectiveness are the goals in treating patients with arrhythmias. In an open prospective study, we observed the efficacy and safety of up to 2 mg intravenous ibutilide, a new class III antiarrhythmic agent in haemodynamically stable patients presenting in the emergency department (ED) with symptoms of recent-onset (<48 h) atrial fibrillation/flutter. Arrhythmia termination within 90 min, haemodynamic parameters and proarrhythmic effects were assessed. Non-responders to the ibutilide infusion underwent external electrical cardioversion. We included 51 patients. In 31 patients therapeutic intervention with intravenous ibutilide was successful within 90 min (61%). In another seven patients conversion to sinus rhythm occurred after 90 min without any other intervention (14%). Blood pressure remained stable and no relevant proarrhythmic effects were observed. The 13 patients who did not respond to ibutilide treatment underwent successful external electrical cardioversion. The overall conversion rate was 100%. Forty-seven patients (92%) were discharged within a median of 9 h and managed as outpatients. In conclusion, in haemodynamically stable patients with recent-onset atrial fibrillation/flutter intravenous ibutilide and external electrical cardioversion for conversion to sinus rhythm turned out to be effective and safe. The short duration of admission makes this strategy attractive for use in the ED.     

Ibutilide to expedite ED therapy for recent-onset atrial fibrillation flutter

OBJECTIVE: Ibutilide is a type III antiarrhythmic agent approved for the pharmacologic conversion of atrial fibrillation (AF) and atrial flutter (AFl). Previous studies conducted outside the ED setting have demonstrated conversion rates of 60% to 80%. This response has been highest in patients with recent-onset AF-AFl. These observations and the 4-hour half-life of ibutilide suggest that it may be an excellent drug with which to treat AF-AFl in the ED. The purpose of the study was to examine the efficacy and safety of ibutilide in terminating AF-AFl in patients who present to the ED with symptoms of less than 3 days' duration, neither angina nor heart failure, and no comorbid conditions that require admission. METHODS: Among 36 enrolled patients, the admission electrocardiogram demonstrated AF in 26 and AFl in 10. Ibutilide 1 mg was administered intravenously for 10 minutes. If sinus rhythm was not present 10 minutes after the infusion concluded, a second infusion of 1 mg was given. Successful conversion was defined as restoration of sinus rhythm within 1 hour after the last dose of ibutilide. RESULTS: Sixteen (61.5%) of 26 patients with AF and 9 (90%) of 10 patients with AFl converted to sinus rhythm (overall conversion rate=69%). The mean time to arrhythmia termination was 19+/-9 minutes. The mean stay in the ED was 16.2 hours. No significant complications occurred. CONCLUSION: We conclude that ibutilide is an excellent therapy option for restoring sinus rhythm in the ED. Its use may obviate the need for admission, avoid the risks and inconveniences of general anesthesia to perform electrical cardioversion, and reduce the ED length of stay in selected patients with recent-onset atrial arrhythmias.     

Termination of acute wide QRS complex atrial fibrillation with ibutilide

Ibutilide is a Vaughan-Williams class III antiarrhythmic agent approved for chemical cardioversion of acute onset atrial fibrillation/flutter. Emergency physicians rarely use ibutilide despite its proven clinical value. We report a case of successful chemical cardioversion using ibutilide in a patient with atrial fibrillation and delayed ventricular depolarization (wide QRS complex). We recommend that ibutilide be considered for wider use in the emergency department and that further studies be conducted.     

Conversion of recent-onset atrial fibrillation or flutter with ibutilide after amiodarone has failed

OBJECTIVE: To evaluate whether ibutilide can convert atrial fibrillation or flutter in patients in whom amiodarone has failed. DESIGN AND SETTING: Clinical study in a university hospital intensive care unit (ICU). PATIENTS: Twenty-six patients were studied, in whom atrial fibrillation or flutter persisted for a maximum of 6 h at maximum. Patients were monitored continuously during the arrhythmia. Medical conversion was necessary due to symptomatic or hemodynamic causes. INTERVENTIONS: All patients initially received amiodarone (150 mg i.v.) and after 2 h of persistent arrhythmia ibutilide (1 mg or, without success and body weight > 70 kg, 2 mg i.v.). Before the administration of ibutilide 1 g magnesium was administered, and high normal levels of potassium serum levels were achieved (4.5-5.0 mmol/l). RESULTS. After amiodarone atrial flutter persisted in 73% and atrial fibrillation in 27% of patients. After ibutilide the QT interval was prolonged from 327 +/- 61 to 387 +/- 62 ms. The QTc interval increased from 456 +/-32 to 461 +/- 66 ms. Conversion to normal sinus rhythm was achieved in 22 of 27 of cases. Nonsustained torsade de pointes tachycardia was seen in three patients (11%). No patient showed sustained ventricular tachycardia. Patients with proarrhythmic effects were characterized by a decreased left ventricular function. CONCLUSIONS: In ICU patients ibutilide led to conversion to sinus rhythm in 81.5% of patients in whom amiodarone was unsuccessful. Nonsustained tachycardias were seen in 11%; sustained ventricular tachycardia was not seen. Ibutilide seems to be well suitable for conversion of recent onset atrial fibrillation or flutter and had no severe side effects in this study population.     

The effect of ibutilide on retrograde accessory pathway conduction

Ibutilide is a compound with Class III effects marketed for rapid conversion of atrial fibrillation and atrial flutter. The Class III effect is primarily mediated by blockade of the rapid component of the cardiac delayed rectifier of potassium current, Ikr. Ibutilide was used in three patients with concealed accessory pathways during electrophysiological evaluation for ablation of symptomatic atrioventricular reentry tachycardia. Each pathway (mid-septal, left posterior, and left lateral) exhibited a mean retrograde effective refractory period of 240 +/- 20 ms. Each patient had atrioventricular reentry tachycardia that consistently degenerated to recurrent sustained atrial fibrillation. One to two milligrams of intravenous ibutilide converted atrial fibrillation to sinus rhythm and maintained sinus rhythm throughout the procedure. Retrograde accessory pathway conduction was unchanged. Maintenance of sinus rhythm allowed for successful mapping and catheter ablation of the concealed accessory pathways. No direct current cardioversion was needed. In these patients, ibutilide was effective in converting and controlling atrial fibrillation induced by atrioventricular reentry tachycardia without masking retrograde pathway conduction. Antegrade accessory pathway conduction could not be assessed in this study.     

Ibutilide-induced long QT syndrome and torsade de pointes

Ibutilide is a class III antiarrhythmic agent used for the termination of atrial fibrillation and atrial flutter. It mainly affects membrane potassium currents and prolongs the cardiac action potential. This effect is reflected as QT interval prolongation on the surface electrocardiogram. Like other drugs that affect potassium currents, ibutilide is prone to induce a malignant ventricular tachycardia, torsade de pointes. We report four cases of torsade de pointes after administration of ibutilide for pharmacologic cardioversion of atrial fibrillation and atrial flutter; three of these cases required direct current cardioversion for termination of torsade de pointes. All four patients were female. We discuss the risk factors for development of ibutilide-induced torsade de pointes.     

Ibutilide for rapid conversion of atrial fibrillation or flutter in a mixed critically ill patient population

INTRODUCTION: Ibutilide is an intravenous class III antiarrhythmic agent that has been shown to be effective in converting acute onset atrial fibrillation/flutter in stable medical and cardio-surgical patients. Data on its use in critically ill patients are rare. The aim of this open, non-randomized, prospective trial was to assess the potential role of ibutilide for conversion of recent onset atrial fibrillation/flutter in a mixed critically ill ICU-population. METHODS: Twenty cardiac-surgical and 17 medical patients with acute tachycardic atrial fibrillation or flutter received up to two 10-min intravenous infusions of 1.0 mg ibutilide. RESULTS: The cumulative conversion efficacy of ibutilide was 56.8% (21 of 37 patients). The mean time to termination of the arrhythmia was 17.7 +/- 12.5 min (range 4 to 45 min) after the start of the first infusion. Conversion success was significantly higher in medical compared to cardiac-surgical patients (82.4 versus 35.0%, p=.0063). In a multivariate binary stepwise logistic regression analysis adjusted for age, heart rate and reduced left ventricular function, cardiac surgery remained significantly associated with a lower conversion probability (RR, .14; 95%CI, 0.02 to 0.76; p=.0190). Serious, ibutilide-induced ventricular arrhythmias developed in 3/37 patients (8.1%). Two of these 3 patients had a left ventricular ejection fraction < 20%. CONCLUSION: Ibutilide is an effective treatment for conversion of acute tachycardic atrial fibrillation/flutter in critically ill patients. Higher efficacy can be expected in medical than cardiac-surgical patients. Ventricular proarrhythmia, especially in patients with severely depressed left ventricular function represents the most important limitation of ibutilide treatment.     

伊布利特与胺碘酮对阵发性房颤复律的疗效比较

[目的]研究Ⅲ类抗心律失常药物依布利特与胺碘酮转复阵发性心房颤动（房颤） 的有效性及安全性.[方法]入选阵发性房颤患者63例（男32例,女31例）,随机进入依布利特组（n=28）、胺碘酮组（n=35）.前者于10 min内静脉注射依布利特1 mg,如给药结束10 min后仍未转复为窦性心律, 重复前述治疗1次.后者于10 min内静脉注射胺碘酮150 mg,后以1 mg/min维持6 h,再以0.5 mg/min维持18 h,转复后即刻停药.观察给药后房颤的转复率、转复时间、心室率、QTc变化及不良反应.[结果] 依布利特组转复率明显高于胺碘酮组（67.9% vs 40.0%,P=0.028）,转复时间明显短于胺碘酮组[（20.11±11.54） min vs （523.31±277.73） min,P=0.000];伊布利特组10 min、30 min时对心室率和QTc影响大于胺碘酮组（P〈0.05）.胺碘酮组有2例出现轻度低血压,1例胃肠炎,伊布利特组出现2例单形室性心动过速,两组患者不良反应率差异无统计学意义（P〉0.05）.[结论] 伊布利特转复阵发性房颤疗效高于胺碘酮,转复时间短,是一种转复房颤快速、有效的药物,但用药前后必须加强心电监护.     

Pharmacokinetic and pharmacodynamic properties of a single intravenous dose of ibutilide fumarate: a phase I, randomized, open-label, increasing-dose study in healthy Chinese men

BACKGROUND: Atrial flutter is a common sustained atrial tachyarrhythmia whose frequency increases with age. Ibutilide is a class III antiarrhythmic agent used for the cardioversion of atrial flutter or atrial fibrillation. OBJECTIVE: This study assessed the pharmacokinetic (PK) and pharmacodynamic properties and tolerability of a single intravenous dose of ibutilide fumarate in healthy Chinese men. METHODS: This Phase I, randomized, open-label, increasing-dose trial was conducted at the Clinical Pharmacology Center, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College in Beijing, People's Republic of China. Healthy, nonsmoking men aged 18 to 45 years and weighing within 15% of their ideal height/weight range were randomly assigned to 1 of 6 treatment groups: ibutilide 0.005, 0.01, or 0.02 mg/kg, or 0.5, 0.75, or 1.0 mg. Each volunteer received a 10-minute infusion of ibutilide under fasting conditions. For analysis of PK properties, blood samples were obtained at the following times: immediately before administration of study drug; 3, 5, 8, 10, 30, and 60 minutes after administration; and 2, 4, 6, 8, 12, and 24 hours after administration. Plasma ibutilide concentrations were determined using a validated high- performance liquid chromatography method with tandem mass-spectrometric detection. Continuous electrocardiographic monitoring was performed, and 12-lead electrocardiograms were recorded before dosing and at defined times from the start of infusion until 24 hours after dosing. Tolerability was assessed throughout the study based on physical examinations, measurement of vital signs, laboratory analyses, and monitoring of adverse effects. RESULTS: Forty healthy Chinese men were enrolled (mean [SD] age, 24.0 [3.9] years [range, 19-36 years]; mean [SD] body weight, 62.8 [7.9] kg [range, 48- 80 kg]). The plasma ibutilide end-of-infusion concentration and AUC(0-infinity) increased approximately linearly with increasing doses of ibutilide. No statistically significant differences in the principal PK parameters were found among dosage groups; t(1/2) ranged from 7.5 to 9.1 hours, systemic clearance from 68 to 85 mL/min per kg, and Vd from 51 to 60 L/kg. The mean QTc interval was significantly increased during and after ibutilide infusion (baseline range, 406-418 milliseconds; maximum range, 469-683 milliseconds; P < 0.05 vs baseline). The changes in QTc interval were dose dependent, and there was a significant correlation between plasma ibutilide concentrations and changes in the QTc interval (r = 0.7244; P < 0.01). There were no significant changes in blood pressure or the QRS and PR intervals. One volunteer complained of dizziness, but no other apparent adverse effects were observed. CONCLUSIONS: The results of this study in a selected population of healthy Chinese men suggest that the PK properties of ibutilide are linear with respect to dosing. A single intravenous dose of ibutilide prolonged the QTc interval in a dose- and concentration- dependent manner. Ibutilide was generally well tolerated.     

Ibutilide versus amiodarone in atrial fibrillation: a double-blinded,randomized study

OBJECTIVE: Ibutilide, a class III antiarrhythmic drug, has been shown to convert atrial fibrillation to sinus rhythm more rapidly than procainamide or sotalol. Our objective was to compare the efficacy and safety of ibutilide and amiodarone in patients after cardiac surgery. DESIGN: Prospective, randomized, double-blinded study. SETTING: Intensive care unit of a university hospital. PATIENTS: Forty adults with an onset of atrial fibrillation within 3 hrs after admission. INTERVENTIONS: Before the administration of antiarrhythmic drugs, a 24-hr Holter electrocardiograph was attached. Patients in the ibutilide group received ibutilide 0.008 mg/kg body weight over 10 mins; treatment was repeated if atrial fibrillation or flutter persisted. If sinus rhythm was not achieved within 4 hrs, amiodarone 5 mg/kg was administered over 30 mins, followed by amiodarone 15 mg/kg over 24 hrs. Patients in the amiodarone group received amiodarone 5 mg/kg over 30 mins, followed by amiodarone 15 mg/kg over 24 hrs if atrial fibrillation or flutter continued. MEASUREMENTS AND MAIN RESULTS: Within the first 4 hrs, atrial fibrillation was converted in nine of 20 patients (45%) in group ibutilide and in ten of 20 patients (50%) in group amiodarone (not significant). Mean time for conversion overall was 385 mins in group ibutilide and 495 mins in group amiodarone (not significant). In group amiodarone, the protocol was discontinued in two patients because of severe arterial hypotension. Atrial fibrillation recurred in 11 of 20 patients (55%) in group ibutilide and in seven of 20 patients (35%) in group amiodarone (not significant). Ventricular arrhythmia did not occur during the first 24 hrs of the protocol. CONCLUSIONS: Ibutilide has no significant advantage over amiodarone for the conversion of atrial fibrillation to sinus rhythm in either time to conversion or conversion overall, but severe hypotension was not seen with ibutilide.     

伊布利特转复房颤110例的疗效分析

目的探讨伊布利特药物复律心房颤动的疗效和安全性,并分析影响转复成功率的因素。方法回顾性分析2009年1月至2011年6月期间110例使用伊布利特行药物复律的心房颤动患者的临床资料。结果 65例患者转复为窦性心律,成功率59.1%;转复组在年龄、合并器质性心脏病的比率、心房颤动发作持续时间及左房内径等方面均小于未转复组,差异有统计学意义(P均<0.05);4例在用药过程中发生频发室性早搏;2例发生非持续性尖端扭转性室速(TdP);所有患者均未出现血流动力学不稳定及其他严重不良反应。结论伊布利特转复心房颤动疗效肯定,转复成功率与年龄、合并器质性心脏病、心房颤动发作持续时间和左房内径等因素有关。用药期间有发生TdP的可能,做好用药期间的监护可以显著减少这一不良反应的发生。     

Efficacy and safety of ibutilide for the conversion of monomorphic atrial tachycardia

BACKGROUND: Ibutilide is a class III antiarrhythmic drug, frequently used for conversion of atrial fibrillation and flutter. We studied the efficacy of ibutilide for acute conversion of monomorphic atrial tachycardia (monoAT) in a prospective, open label study in the intensive care unit of a cardiological clinic. METHODS: We examined 49 episodes of monoAT in 38 patients (19 men/19 women). Thirty-three patients (87%) suffered from structural heart disease. Twenty-three episodes occurred while on antiarrhythmic therapy with class I or III drugs. Patients with prolonged QT interval (except for patients with pretreatment with class III drugs), hypokalemia, left ventricular failure, and recent myocardial infarction were excluded. All patients received one or two doses of 1 mg ibutilide fumarate under continuous rhythm monitoring. RESULTS: Conversion to sinus rhythm occurred in 19 episodes (38.8%), in 6 episodes (12.2%) after the first dose. Conversion rate was significantly higher in patients with a short history of symptoms (66.6% vs 28.6%; P < 0.05), of documented arrhythmia (0.13 (0/5.7) vs 2.6 (0.38/23.5) months, median (interquartile range); P < 0.03), higher atrial rate (272 +/- 49 vs 207 +/- 36 beats/min (means +/- SD); P < 0.004), or without preexisting antiarrhythmic therapy (53.8% vs 21.7%; P < 0.02). No differences in conversion rates were found regarding gender, age, body mass index, left ventricular function, left atrial diameter, or underlying disease. In three episodes torsade de pointes occurred after ibutilide (6.1%), requiring defibrillation in two cases (4.1%). CONCLUSIONS: Ibutilide can be used for conversion of monoAT with a similar efficacy as for atrial fibrillation, but with a considerably lower efficacy compared to typical atrial flutter.     

Ibutilide: a class III rapidly acting antidysrhythmic for atrial fibrillation or atrial flutter

Ibutilide is an intravenous Class III antidysrhythmic approved for the treatment of recent onset atrial fibrillation or atrial flutter. Pharmacological effect occurs within 30 min, and the efficacy approaches 40%. In contrast to DC electrical cardioversion, which requires anesthesia, pharmacologic cardioversion offers an alternative in which sedation can be avoided. Patients receiving ibutilide should be monitored for at least 4 h after completed drug administration because of a small chance of ventricular dysrhythmia, mainly torsades de pointes. Careful patient selection is the key to avoiding dysrhythmic complications. The purpose of this article is to review the mechanisms, clinical applications, potential complications, and appropriate use of ibutilide.     

Ibutilide for treatment of atrial fibrillation in the emergency department

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.     

Comparison of intravenous ibutilide vs. propafenone for rapid termination of recent onset atrial fibrillation

This study was to evaluate the efficacy and safety of ibutilide and propafenone given intravenously in converting recent onset atrial fibrillation (AF). Eighty-two consecutive patients with AF (onset in 2 h to 90 days) were randomly assigned to receive two 10-min infusions, 10 min apart, of either ibutilide (1 mg) or propafenone (70 mg). The treatment was considered successful if sinus rhythm occurred within 90 min after the beginning of infusion. Ibutilide had a significantly higher rate of cardioversion than propafenone (70.73 vs. 48.78%, p = 0.043). The patients with shorter AF duration or smaller left atrium diameter had a higher success rate. Nonsustained monomorphic ventricular tachycardia was the most serious adverse effect of ibutilide in 9.76% of patients, and hypotension and heart pause were the major serious adverse events in 17.07% of patients treated with propafenone. Ibutilide is more effective than intravenous propafenone for the cardioversion of recent onset AF, and the adverse effects are rare and transient.     

伊布利特治疗预激综合征合并房颤患者的临床疗效观察

[目的]探讨伊布利特治疗预激综合征合并房颤的临床疗效.[方法]回顾性分析2017年2月至2019年6月本院收治的7例预激综合征合并房颤患者,所有患者均给予富马酸依布利特注射液治疗,所有患者在用药后均行预激旁道和(或)房颤射频消融术治疗.观察记录所有患者用药后窦性心律转复情况及手术情况.[结果]7例患者静脉注射伊布利特后...