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

Kafkas, Nikolaos; Patsilinakos, Sotirios; Mertzanos, George; Papageorgiou, Kostas I.; Chaveles, John I.; Dagadaki, Ourania; Kelesidis, K.M.

doi:10.1016/j.ijcard.2006.07.017

Cited by 60 publications

(46 citation statements)

References 17 publications

(19 reference statements)

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“…More than 80% of patients with recentonset atrial flutter are converted to sinus rhythm within 30 minutes of drug administration. 16 The same study 16 compared the efficacy of intravenous ibutilide to intravenous amiodarone in the conversion of atrial fibrillation or atrial flutter, and the conversion rate was found to be significantly higher with ibutilide (80% vs 57%; P ϭ .0054). A subanalysis of the same study showed no significant difference in the conversion rate between these drugs in patients with atrial fibrillation (77% vs 69%; P ϭ NS); however, when used for atrial flutter, ibutilide was superior to amiodarone (87% vs 29%; P ϭ .003).…”

Section: Use Of Ibutilide In Chemical Cardioversion In Acute Atrial Fmentioning

confidence: 99%

“…It was concluded that ibutilide was more effective than amiodarone in converting recent-onset atrial flutter to sinus rhythm, but both drugs are equally effective in converting recentonset atrial fibrillation to sinus rhythm. 16 In newonset arrhythmia, a single dose of ibutilide successfully converted 53% patients' fibrillation or flutter into sinus rhythm, and an additional 22% patients converted with the second dose, which resulted in an overall conversion rate of 75%. 17 Female sex and younger age were independent predictors of successful cardioversion with ibutilide.…”

Section: Use Of Ibutilide In Chemical Cardioversion In Acute Atrial Fmentioning

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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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: Use Of Ibutilide In Chemical Cardioversion In Acute Atrial Fmentioning

confidence: 99%

Section: Use Of Ibutilide In Chemical Cardioversion In Acute Atrial Fmentioning

confidence: 99%

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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“…297,303,304 Rhythm Control of Atrial Fibrillation. Ibutilide has consistently been more effective in converting atrial fibrillation to sinus rhythm when compared with placebo (LOE 1), [305][306][307] or other antiarrhythmic drugs (LOE 1: sotalol, 308 procainamide, 309 and amiodarone, 310 ) and equal to other drugs (LOE 1: flecainide 311 ).…”

Section: Consensus On Sciencementioning

confidence: 99%

Part 8: Advanced Life Support

Morrison¹,

Deakin²,

Morley³

et al. 2010

Circulation

411

169

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“…It is used as a first-line drug in the treatment of recent-onset AF and atrial flutter. In rapid onset (3-48 h), the cardioversion rate of atrial flutter with ibutilide was 87%, and the cardioversion rate of AF with ibutilide was 77% (12). However, the efficacy of treatment of ibutilide in the cardioversion of persistent AF is not as effective as the curative effect for acute AF.…”

Section: Discussionmentioning

confidence: 99%

“…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). With long-term administration, amiodarone markedly prolongs the ventricular action potential and the QT interval (13); however, the incidence of torsade de pointes is low (18,19).…”

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.

show abstract

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

Cited by 60 publications

References 17 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

Part 8: Advanced Life Support

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

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