Acute beta-adrenoceptor blockade improves efficacy of ibutilide in conversion of atrial fibrillation with a rapid ventricular rate

Bikias, Athanasios; Delithanasis, I.; Konstantinidou, Melania; Liakopoulos, Nikolaos; Kozirakis, Miltiadis; Katsaris, George

doi:10.1093/europace/eun302

Cited by 18 publications

(10 citation statements)

References 26 publications

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“…48 hours) dysrhythmias and use single-strategy cardioversion (i.e., drug or direct current). A study using esmolol prior to ibutilide cardioversion showed that it improved the odds of conversion 11 ; however, this was a small, nonblinded study that excluded patients with AF duration , 24 hours and thus has limited applicability to the ED population. Evidence is mixed on whether using antiarrhythmics prior to electrical cardioversion influences success.…”

Section: Comparison To Prior Studiesmentioning

confidence: 99%

Use of rate control medication before cardioversion of recent-onset atrial fibrillation or flutter in the emergency department is associated with reduced success rates

Blecher

Stiell

Rowe

et al. 2012

CJEM

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Objective: It is believed that when patients present to the emergency department (ED) with recent-onset atrial fibrillation or flutter (RAFF), controlling the ventricular rate before cardioversion improves the success rate. We evaluated the influence of rate control medication and other variables on the success of cardioversion.Methods: This secondary analysis of a medical records review comprised 1,068 patients with RAFF who presented to eight Canadian EDs over 12 months. Univariate analysis was performed to find associations between predictors of conversion to sinus rhythm including use of rate control, rhythm control, and other variables. RÉ SUMÉObjectif: On croit que lorsqu'un patient se pré sente au service des urgences (SU) en é tat de fibrillation auriculaire (flutter) ré cente, le contrôle de la fré quence ventriculaire avant l'amé lioration de la cardioversion augmente le taux de ré ussite. Nous avons é valué l'influence des mé dicaments de contrô le de la fré quence et d'autres variables sur l'amé lioration de la cardioversion. Mé thodes: Cette deuxiè me analyse des dossiers mé dicaux porte sur 1 068 patients en é tat de fibrillation auriculaire (flutter) ré cente qui se sont pré senté s dans huit services des urgences au Canada au cours des 12 derniers mois. Une analyse univarié e a é té effectué e afin d'é tablir des liens entre les pré dicteurs de conversion et le rythme sinusal, y compris le contrô le de la fré quence, le contrô le du rythme, et d'autres variables. Les variables pré dictives ont é té inté gré es au modè le à plusieurs variables afin de calculer les ratios d'incidence approché s (RIA) redressé s associé s à la ré ussite de la cardioversion. (IC 95 % 0,83). Les RIA pour les facteurs lié s aux cardioversions pharmacologiques ré ussies é taient l'utilisation de mé dicaments de contrô le de la fré quence, 1,29 (IC 95 % 0,82-2,03); le sexe fé minin, 2,37 (IC 95 % 1,50-3,72); et l'utilisation de la procaïnamide, 2,32 (CI 95 % 1,43-3,74).Conclusion: Nous avons dé montré un taux de ré ussite plus faible des cardioversions pour les patients en é tat de fibrillation auriculaire (flutter) ré cente lorsque ces derniers avaient pré alablement pris des mé dicaments de contrô le de la fré quence ou du rythme. Les mé dicaments de contrô le de la fré quence n'é taient pas associé s à un taux de ré ussite plus é levé des cardioversions pharmacologiques, contrairement à la procaïnamide. Il faudrait é viter de ralentir la fré quence ventriculaire avant la cardioversion.Keywords: atrial fibrillation, cardioversion, rate control Atrial fibrillation (AF) affects an estimated 2.2 million Americans and is present in 8 to 10% of those over 80 years old.1 The major morbidity associated with AF or atrial flutter (AFL) is from thromboembolism, particularly to the cerebral circulation. In managing this risk, one of two competing management strategies is recommended: rate control or rhythm control.Symptomatic AF or AFL with rapid ventricular response is a common presentation to emergency departments (ED...

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Section: Comparison To Prior Studiesmentioning

confidence: 99%

Use of rate control medication before cardioversion of recent-onset atrial fibrillation or flutter in the emergency department is associated with reduced success rates

Blecher

Stiell

Rowe

et al. 2012

CJEM

View full text Add to dashboard Cite

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“…A previous study indicated that the conversion rate of persistent AF (duration, >30 days) with ibutilide was 48% (13). Furthermore, ibutilide may induce QT interval prolongation and increase the risk of torsade de pointes, as a result of prolonging the action potential duration (APD) by increasing the slow inward sodium current and blocking the delayed rectifier potassium current (14)(15)(16). Amiodarone has a complex electrophysiological characteristic (12,17).…”

Section: Discussionmentioning

confidence: 99%

Pretreatment with intravenous amiodarone improves the efficacy of ibutilide treatment on cardioversion rate and maintenance time of sinus rhythm in patients with persistent atrial fibrillation

et al. 2017

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Abstract. The aim of the present study was to assess the efficacy and safety of the pharmacological conversion of persistent atrial fibrillation (AF) using amiodarone or/and ibutilide. Seventy-nine consecutive patients (48 males and 31 females; mean age, 64.6±11.2 years; range, 40-80 years) with non-valvular chronic AF lasting >7 days (range, 7-97 days) that were admitted to hospital for elective pharmacological cardioversion were randomly assigned to receive treatment with intravenous ibutilide (1 mg plus an additional 1 mg if required; n=39) or intravenous amiodarone (300 mg) plus intravenous ibutilide (1 mg; n=40). Success rates of cardioversion were 51.3% (20/39 patients) for ibutilide alone and 71.8% (28/39 patients) for amiodarone + ibutilide (P<0.05). A comparable increase in the QTc interval was observed in the two groups. It was observed that the co-administration of amiodarone and ibutilide was safer than ibutilide alone with regard to the risk of ventricular arrhythmia. Forty-eight patients of successful cardioversion were personally contacted for follow-up. The result indicated that the sinus rhythm maintenance time of the amiodarone + ibutilide group (4.36±2.44 months) was significantly higher than that of the ibutilide group (2.34±1.75 months; P<0.01). In conclusion, pretreatment with intravenous amiodarone + ibutilide for pharmacological cardioversion of persistent AF is considered to be more effective and safer than treatment with ibutilide alone.

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“…46 In contrast, a post hoc analysis of ATHENA (A Placebo-Controlled, Double-Blind, Parallel Arm Trial to Assess the Efficacy of Dronedarone 400 mg bid for the Prevention of Cardiovascular Hospitalization or Death from any Cause in Patients with Atrial Fibrillation/Atrial Flutter) study patients with AF and stable HF demonstrated that dronedarone did not increase mortality and showed a reduction of cardiovascular hospitalization or death similar to the overall population. 56 Sotalol is a class III AAD with strong β-blocking effects. 48 The most recently published PALLAS (Permanent Atrial Fibrillation Outcome Study Using Dronedarone on Top of Standard Therapy) 69 study, which was prematurely terminated, demonstrated that dronedarone increased the rates of HF, stroke, and death from cardiovascular causes in patients with permanent AF who were at risk for major vascular events, thus raising serious concerns about dronedarone's clinical utility in the future.…”

Section: Pharmacologic Agents For Rhythm Control In Atrial Fibrillatimentioning

confidence: 99%

Management Strategies in Atrial Fibrillation in Patients With Heart Failure

Shaikh

Maan²,

Heist³

et al. 2012

Cardiology in Review

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Atrial fibrillation (AF) and heart failure (HF) frequently occur together, and their coexistence is associated with a poor prognosis. AF and HF share risk factors, but their relationship involves complex hemodynamic, neurohormonal, inflammatory, ultrastructural, and electrophysiologic processes that extend beyond epidemiological associations. The shared mechanisms underlying AF and HF have important implications for the treatment of AF in patients with HF. This article focuses on reviewing contemporary data as it pertains to AF management in patients with HF and provides insight into investigational therapies currently under development.

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Acute beta-adrenoceptor blockade improves efficacy of ibutilide in conversion of atrial fibrillation with a rapid ventricular rate

Cited by 18 publications

References 26 publications

Use of rate control medication before cardioversion of recent-onset atrial fibrillation or flutter in the emergency department is associated with reduced success rates

Use of rate control medication before cardioversion of recent-onset atrial fibrillation or flutter in the emergency department is associated with reduced success rates

Pretreatment with intravenous amiodarone improves the efficacy of ibutilide treatment on cardioversion rate and maintenance time of sinus rhythm in patients with persistent atrial fibrillation

Management Strategies in Atrial Fibrillation in Patients With Heart Failure

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