Effect of High Doses of Magnesium on Converting Ibutilide to a Safe and More Effective Agent

Patsilinakos, Sotirios; Christou, Apostolos; Kafkas, Nikolaos; Νικολάου, Νικόλαος; Antonatos, Dionysios G.; Katsanos, Spyridon; Spanodimos, Stavros G.; Babalis, Dimitrios

doi:10.1016/j.amjcard.2010.04.020

Cited by 37 publications

(20 citation statements)

References 19 publications

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“…Ibutilide should be avoided in patients with QT prolongation, marked hypokalemia, or a very low ejection fraction (EF) (<30%) because of the risk of ventricular proarrhythmia (327). Some experts administer magnesium sulfate intravenously prior to administering ibutilide in an attempt to lower this risk (331). Intravenous amiodarone may facilitate slowing of the ventricular rate in AF, but the effect to restore sinus rhythm is often delayed.…”

Section: Rhythm Controlmentioning

confidence: 99%

2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation

January¹,

Wann²,

Alpert³

et al. 2014

Circulation

3,529

1,139

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Section: Rhythm Controlmentioning

confidence: 99%

2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation

January¹,

Wann²,

Alpert³

et al. 2014

Circulation

3,529

1,139

View full text Add to dashboard Cite

“…53,54 The incidence of ventricular arrhythmias including torsade de pointes may also be reduced with intravenous infusion of high-dose magnesium sulfate. 55,56 Precautions should be taken to reduce this risk of fatal arrhythmia by the appropriate selection of patients for ibutilide treatment, correction of serum potassium and magnesium abnormalities, ensuring immediate availability of resuscitation equipment, and monitoring for at least 4 hours after ibutilide infusion.…”

Section: Adverse Effects Of Ibutilidementioning

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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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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“…Impact of magnesium supplementation on the efficacy of ibutilide in converting AF or atrial flutter patients was studied in 5 previous trials 7,17,18,19,20. Two of the 5 trials were retrospective.…”

Section: Resultsmentioning

confidence: 99%

Efficacy of class III antiarrhythmics and magnesium combination therapy for atrial fibrillation

Wang

2012

Pharmacy Practice (Internet)

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*Atrial fibrillation is a common cardiac arrhythmia, and has been a significant financial burden. Class III antiarrhythmics such as dofetilide, ibutilide, and amiodarone are indicated for rhythm control. Magnesium may possess intrinsic antiarrhythmic properties, and may potentially increase the efficacy of class III antiarrhythmics when used concomitantly. Objective: The purpose of this article is to review the literature on the efficacy of magnesium in addition to Class III antiarrhythmics, specifically amidarone, ibutilide, and dofetilide for the cardioversion of atrial fibrillation. Methods: Databases Pubmed and CINAHL are utilized along with the search terms amiodarone, dofetilide, ibutlide, magnesium, atrial fibrillation, conversion, rhythm control, and cardioversion. Results: One study on dofetilide and 5 studies on ibutilide were identified. No studies were found on amiodarone. Patients with atrial fibrillation who received dofetilide and magnesium had higher rates of successful cardioversion as compared to those who only received dofetilide. Conversion rates were similar between the 2 treatment groups for patients with atrial flutter. As for ibutilide, 4 studies have shown that the addition of magnesium significantly increases conversion rates for patients with atrial fibrillation or typical atrial flutter. Conversion rates were similar for patients with atypical atrial flutter. One study showed that addition of magnesium did not improve efficacy of ibutilide. Higher doses of magnesium (4 g) were associated with improved outcomes. Adverse effects of magnesium were mild and included flushing, tingling, and dizziness. Patients who received magnesium had shorter corrected QT intervals and smaller increase in corrected QT interval from baseline. Compare to previous studies, studies included in this review had higher conversion rates for dofetilide and ibutilide as well as dofetilide and magnesium or ibutilide and magnesium combination therapies. However, only 2 ibutilide studies and 1 dofetilide study reported baseline characteristics such as left atrial size, history of heart failure, and duration of atrial fibrillation, which are significant predictors of successful cardioversion. Therefore, differences in baseline demographics may have influenced the results. Conclusion:Magnesium may be used as adjunct for dofetilide and ibutilide due to potential improved efficacy and minimal toxicity. Dose ranging studies should be conducted in the future to establish the optimal dose and duration of therapy as well as the optimal serum magnesium concentration in order for the clinician to manage and monitor patients appropriately.Keywords: Atrial Fibrillation. Atrial Flutter. AntiArrhythmia Agents. Magnesium Sulfate. EFICACIA DEL TRATAMIENTO DE COMBINACIÓN DE ANTIARRITMICOS CLASE III Y MAGNESIO PARA LA FIBRILACIÓN AURICULAR RESUMENLa fibrilación auricular es una arritmia cardiaca frecuente, y se ha identificado como una carga financiera significativa. Los anti-arrítmicos clase III como la dofetilida, ibutilid...

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Effect of High Doses of Magnesium on Converting Ibutilide to a Safe and More Effective Agent

Cited by 37 publications

References 19 publications

2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation

2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation

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

Efficacy of class III antiarrhythmics and magnesium combination therapy for atrial fibrillation

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