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

Abstract

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.

Conversion efficacy of intravenous ibutilide compared with intravenous amiodarone in patients with recent-onset atrial fibrillation and atrial flutter

“…The mean time to arrhythmia termination was 10-23 min. In other studies, ibutilide was superior to propafenone for treating Af (90% vs. 30%, p b 0.01) [16] and AF (70.73% vs. 48.78%) [17]. In a comparison study, ibutilide was found superior than Sotalol in terminating Af (70% vs. 56%) and AF (44% vs. 11%) [18].…”

Current Drug Treatment Strategies for Atrial Fibrillation and TASK-1 Inhibition as an Emerging Novel Therapy Option

“…The cardioversion rate of ibutilide in recent-onset AF is reported to be around 43-77% and the mean time to cardioversion after intravenous infusion 26-54 min (Gowda et al, 2003;Kafkas et al, 2007;Simon et al, 2017;Vogiatzis et al, 2017). Kafkas et al (2007) showed in their study that ibutilide is superior in cardioversion time to amiodarone with no significant difference in cardioversion rate and Zhang et al (2005) showed a superiority to propafenone in cardioversion rate but not time. It is similar to flecainide (Reisinger et al, 2004) and inferior to vernakalant (Simon et al, 2017;Vogiatzis et al, 2017) in time and rate of cardioversion.…”

“…Propafenone has a cardioversion rate of 49-85% in recentonset AF, depending on the observation time point and the route of administration, and a mean time of cardioversion of 29-30 min after intravenous and 166-287 min after oral administration (Capucci et al, 1999;Madonia et al, 2000;Martínez-Marcos et al, 2000;Khan, 2001;Zhang et al, 2005;Balla et al, 2011;Conde et al, 2013). Studies comparing propafenone to other drugs showed an inferiority to vernakalant in both time and rate of cardioversion (Conde et al, 2013) as well as flecainide (Martínez-Marcos et al, 2000;Balla et al, 2011), to ibutilide in rate with a non-significant inferiority in time (Zhang et al, 2005) and superiority to amiodarone in rate and time (Martínez-Marcos et al, 2000;Balla et al, 2011). Adverse events observed under the treatment of propafenone mostly affect the cardiovascular, gastrointestinal and nervous system.…”

World Heart Federation Roadmap on Atrial Fibrillation – A 2020 Update

“…Compared to rate-control drugs, antiarrhythmic drugs for rhythm-control carry a higher risk of significant cardiac and extracardiac side effects so therapy requires closer medical monitoring and follow-up [ 125 ]. Moreover, as most membrane-active antiarrhythmic drugs are contraindicated in patients with structural heart disease (particularly ischemic heart disease and advanced heart failure), exclusion of such disease (including ECG, cardiac imaging, and in selected cases cardiac catheterization) is often necessary before therapy initiation [ 128 129 130 131 132 133 134 ]. Thus, in geographies without such diagnostic and monitoring facilities it is difficult and potentially risky to promote rhythm control with antiarrhythmic drugs.…”