Efficacy and Safety of Repeated Intravenous Doses of Ibutilide for Rapid Conversion of Atrial Flutter or Fibrillation

Stambler, Bruce S.; Wood, Mark A.; Ellenbogen, Kenneth A.; Perry, Kimberly T.; Wakefield, Linda K.; VanderLugt, James T.

doi:10.1161/01.cir.94.7.1613

Cited by 438 publications

(250 citation statements)

References 47 publications

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“…Alternatywny lek to ibutilid, jeżeli jest on dostępny, ale jego stosowanie wiąże się z ryzykiem wystąpienia torsade de pointes [615]. Wernakalant [602][603][604][605] można podawać pacjentom z mało nasiloną niewydolnością serca (I lub II klasa wg NYHA), włącznie z pacjentami z chorobą niedokrwienną serca, pod warunkiem że nie stwierdza się u nich niskich wartości ciśnienia tętniczego ani ciężkiej stenozy aortalnej [616][617][618].…”

Section: Leki Antyarytmiczne W Celu Doraźnego Przywracania Rytmu Zatounclassified

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Kirchhof

Benussi

Kotecha³

et al. 2016

Kardiol Pol

2,339

4,206

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Section: Leki Antyarytmiczne W Celu Doraźnego Przywracania Rytmu Zatounclassified

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Kirchhof

Benussi

Kotecha³

et al. 2016

Kardiol Pol

2,339

4,206

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“…24) With respect to its mechanism of action, ibutilide has been shown to activate the slow inward Na + current 25) and to block the rapidly activating delayed rectifier K + current. 26) Previous work from our laboratory has shown that intravenous administration of ibutilide in patients without AF significantly increases RA MAPD and the ERP at pacing CLs of 600 and 350 ms in a weak reverse ratedependent manner and that IACT does not change at pacing CLs of 600 and 350 ms (Table IV).…”

Section: Effects Of Class III Antiarrhythmic Drugs In the Remodeled Hmentioning

confidence: 99%

Rate-Dependent Electrophysiologic Effects of the Class III Antiarrhythmic Drugs Nifekalant, Amiodarone, and Ibutilide on the Atrium in Patients With Persistent Atrial Fibrillation

et al. 2013

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SummaryPersistent atrial fibrillation (AF) is characterized by electrical remodeling, ie, marked decreases in the atrial effective refractory period (ERP), ERP rate adaptation, and atrial conduction velocity. Little information is available on the effects of class III antiarrhythmic drugs on the remodeled atrium. We studied the effects of the class III antiarrhythmic drugs nifekalant, ibutilide, and amiodarone on rate-dependent changes in atrial action potential duration in patients with persistent AF. Right atrial (RA) monophasic action potential duration (MAPD) and intra-atrial conduction time (IACT) were measured at pacing cycle lengths (CLs) of 800, 700, 600, 500, 400, 350, 300, and 250 ms before and after administration of nifekalant (0.4 mg/kg + 0.3 mg/kg/hr, iv), amiodarone (5 mg/kg, iv), or ibutilide (0.01 mg/kg, iv) in 31 patients after successful internal cardioversion of chronic AF of > 2 months duration. Nifekalant and ibutilide significantly increased RA MAPD and the ERP at each CL in a reverse rate-dependent manner. Amiodarone did not affect RA MAPD. Nifekalant did not affect IACT, whereas amiodarone increased IACT at each CL in a rate-dependent manner, and ibutilide increased IACT at CLs ≤ 350 ms. The atrial electrophysiologic effects of the class III antiarrhythmic drugs nifekalant, amiodarone, and ibutilide differ, depending on the degree of electrical and structural remodeling and the effects of the drugs on the depolarizing and repolarizing currents. 2) A better understanding of the mechanisms determining antiarrhythmic drug efficacy would help to improve therapy. Under awareness of the risks of potent class I antiarrhythmic drugs made apparent by the Cardiac Arrhythmia Suppression Trial and subsequent analysis, developers shifted to class III antiarrhythmic agents.2-4) Clinical trials have shown class III drugs to be relatively ineffective in terminating AF but effective in preventing its recurrence.5) Experimental studies in vagotonic and atrial tachycardia-related models of sustained AF have shown limited capacity of clinically-relevant doses of class III rapid delayed rectifier (I Kr )-selective blocking agents to terminate AF.6-8) Wang, et al 6) showed that reverse use-dependent actions may limit class III drug efficacy at the rapid rates characteristic of AF but permit these drugs to prevent AF induction by premature complexes at slower resting sinus rates. Furthermore, recent experimental studies have shown that persistent AF causes progressive electrophysiologic changes in the atrial myocardium that make the atria more vulnerable to fibrillation.9,10) Thus, it is plausible to assume that this process of electrical remodeling during persistent AF also influences the efficacy of antiarrhythmic drugs. We therefore designed the present study to investigate the electrophysiologic effects of the different class III agents nifekalant, 11) amiodarone, and ibutilide on the remodeled atrium in patients with sustained AF. MethodsPatients: The subjects were 31 consecutive patients (26 men, 5 wom...

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“…It prolongs the action potential duration and effective refractory periods in both the atria and the ventricles. [1][2][3][4][5] In previous studies, ibutilide significantly prolonged the QTc interval in ECG studies in healthy volunteers and patients with AF or AFl. [2][3][4][5] This effect was dose related and correlated directly with plasma ibutilide concentrations.…”

Section: Ibutilide-induced Repolarization Alterationsmentioning

confidence: 99%

“…[1][2][3][4][5] In previous studies, ibutilide significantly prolonged the QTc interval in ECG studies in healthy volunteers and patients with AF or AFl. [2][3][4][5] This effect was dose related and correlated directly with plasma ibutilide concentrations. 3 In this study, although QT maximum, QT minimum, and QT dispersion significantly increased from baseline to the postinfusion ECG in Group 1 patients, QTc maximum failed to demonstrate significant changes from the first to the second ECG.…”

Section: Ibutilide-induced Repolarization Alterationsmentioning

confidence: 99%

“…1 Ibutilide significantly prolonged the rate-corrected QT (QTc) interval in electrocardiographic (ECG) studies in healthy volunteers and patients with AF or AFl. [2][3][4][5] This effect was dose related and correlated directly with plasma ibutilide concentrations. 3 The QTc interval reflects the duration of repolarization of the ventricles, and its prolongation is indicative of class III antiarrhythmic activity.…”

Section: Introductionmentioning

confidence: 99%

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Ibutilide‐induced alterations in electrocardiographic and spatial vectorcardiographic descriptors of ventricular repolarization

Dilaveris

Theoharis

Giaouris

et al. 2004

Clinical Cardiology

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SummaryBackground: Ibutilide is used for the pharmacologic cardioversion of atrial fibrillation (AF) or flutter (AFl). Ibutilideinduced QT interval prolongation has been demonstrated previously. However, its effects on vectorcardiographic (VCG) descriptors of ventricular repolarization (VR) have not been studied so far.Hypothesis: To evaluate the effects of ibutilide on electrocardiographic (ECG) and VCG descriptors of VR, one or two repeated 10-min infusions of 1 mg of ibutilide were given in 50 consecutively recruited patients (36 women, mean age 69.4 ± 9.3 years) with AF or AFl of recent onset.Methods: The maximum and the minimum QT intervals, QT dispersion, the rate-corrected QT maximum, and the spatial VCG descriptors, spatial T amplitude, and spatial QRS-T angle were calculated before (baseline ECG) and 30 min after the start of ibutilide infusion (postinfusion ECG).Results: After ibutilide infusion, 40 (80%) patients were cardioverted to sinus rhythm (Group 1), while in the remaining 10 (Group 2) AF or AFl persisted. In both study groups, temporal measures of VR were significantly increased from baseline to the postinfusion ECG. In Group 1, spatial T amplitude and spatial QRS-T angle did not differ between those two ECGs, while in Group 2 spatial T amplitude was significantly increased (p = 0.005) and spatial QRS-T angle was significantly decreased (p = 0.002) post infusion compared with baseline ECG.Conclusions: While temporal measures of VR are significantly affected in all patients who receive ibutilide infusion for AF or AFl cardioversion, spatial VCG descriptors of VR are

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Efficacy and Safety of Repeated Intravenous Doses of Ibutilide for Rapid Conversion of Atrial Flutter or Fibrillation

Abstract: Intravenous ibutilide given in repeated doses is effective in rapidly terminating atrial fibrillation and flutter and under monitored conditions is an alternative to current cardioversion options.

Cited by 438 publications

References 47 publications

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Rate-Dependent Electrophysiologic Effects of the Class III Antiarrhythmic Drugs Nifekalant, Amiodarone, and Ibutilide on the Atrium in Patients With Persistent Atrial Fibrillation

Ibutilide‐induced alterations in electrocardiographic and spatial vectorcardiographic descriptors of ventricular repolarization

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