Ibutilide to expedite ED therapy for recent-onset atrial fibrillation flutter

Mountantonakis, Stavros; Moutzouris, Dimitrios Anestis; Tiu, Ramon V.; Papaioannou, Georgios N.; McPherson, Craig A.

doi:10.1016/j.ajem.2005.12.006

Cited by 11 publications

(9 citation statements)

References 33 publications

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“…While most of the controversy regarding AF management has involved patients with arrhythmia durations of less than 48 hours, many patients arrive outside of this time and can only be managed by rate control. Rate control appears safe, as evidenced by the low rate of ED adverse events and strokes or deaths at 30 days, but clinicians have a variety of options and the relative effectiveness of CCB or BB is unclear.…”

Section: Discussionmentioning

confidence: 99%

“…Most ED‐based studies have evaluated the safety of rhythm control, or compared rate versus rhythm control, in patients with AF of less than 48 hours’ duration; however, many patients fall outside this time frame and are not eligible for rhythm control. The American Heart Association/American College of Cardiology 2006 guidelines describe six medications (esmolol, metoprolol, propanolol, diltiazem, verapamil, and digoxin) for acute rate control in these patients .…”

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confidence: 99%

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Safety and Efficiency of Calcium Channel Blockers Versus Beta‐blockers for Rate Control in Patients With Atrial Fibrillation and No Acute Underlying Medical Illness

Scheuermeyer

Grafstein

Stenstrom

et al. 2013

Academic Emergency Medicine

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Objectives Many patients with atrial fibrillation (AF) are not candidates for rhythm control and may require rate control, typically with beta‐blocking (BB) or calcium channel blocking (CCB) agents. Although these patients appear to have a low 30‐day rate of stroke or death, it is unclear if one class of agent is safer or more effective. The objective was to determine whether BBs or CCBs would have a lower hospital admission rate and to measure 30‐day safety outcomes including stroke, death, and emergency department (ED) revisits. Methods This retrospective cohort study used a database from two urban EDs to identify consecutive patients with ED discharge diagnoses of AF from April 1, 2006, to March 31, 2010. Comorbidities, rhythms, management, and immediate outcomes were obtained by manual chart review, and patients with acute underlying medical conditions were excluded by predefined criteria. Patients managed only with rate control agents were eligible for review, and patients receiving BB agents were compared to those receiving CCB agents. The primary outcome was the proportion of patients requiring hospital admission; secondary outcomes included the ED length of stay (LOS), the proportion of patients having adverse events, the proportion of patients returning within 7 or 30 days, and the number of patients having a stroke or dying within 30 days. Results A total of 259 consecutive patients were enrolled, with 100 receiving CCBs and 159 receiving BBs. Baseline demographics and comorbidities were similar. Twenty‐seven percent of BB patients were admitted, and 31.0% of CCB patients were admitted (difference = 4.0%, 95% confidence interval [CI] = −7.7% to 16.1%), and there were no significant differences in ED LOS, adverse events, or 7‐ or 30‐day ED revisits. One patient who received metoprolol had a stroke, and one patient who received diltiazem died within 30 days. Conclusions In this cohort of ED patients with AF and no acute underlying medical illness who underwent rate control only, patients receiving CCBs had similar hospital admission rates to those receiving BBs, while both classes of medications appeared equally safe at 30 days. Both CCBs and BBs are acceptable options for rate control.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Safety and Efficiency of Calcium Channel Blockers Versus Beta‐blockers for Rate Control in Patients With Atrial Fibrillation and No Acute Underlying Medical Illness

Scheuermeyer

Grafstein

Stenstrom

et al. 2013

Academic Emergency Medicine

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“…[19][20][21] IV ibutilide is a widely used agent with effectiveness for both atrial fibrillation and flutter. 15,[22][23][24][25][26][27] Ibutilide has a 4% incidence of torsades de pointes, and serum potassium and magnesium levels should be measured before use. Propafenone can be used orally or intravenously and appears to be effective in 56%-83% of cases, although the IV formulation is not available in the United States.…”

Section: Discussionmentioning

confidence: 99%

Emergency Department Use of Intravenous Procainamide for Patients with Acute Atrial Fibrillation or Flutter

Stiell

Clement

Symington

et al. 2007

Academic Emergency Medicine

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“…successful conversion rates, respectively [22,23] .The use of IV ibutilide resulted in conversion rates ranging from 64% to 76% [24,25,26,28] . IV procainamide was used by Stiell et al and White et al with a 50% and 67% success rate, respectively [27,30] .…”

Section: Electrical Cardioversion-based Protocolsmentioning

confidence: 99%

Management and Disposition of Atrial Fibrillation in the Emergency Department: A Systematic Review

Vandermolen

Sadaf

Gehi

2018

Journal of Atrial Fibrillation

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Introduction: Management of atrial fibrillation (AF) and atrial flutter (AFL) in the emergency department (ED) varies greatly, and there are currently no United States guidelines to guide management with regard to patient disposition after ED treatment. The aim of this systematic review was to evaluate the literature for decision aids to guide disposition of patients with AF/AFLin the ED, and assess potential outcomes associated with different management strategies in the ED.Methods and Results: A systematic review was done using PubMed (MEDLINE), Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE, combining the search terms "Atrial Fibrillation", "Atrial Flutter", "Emergency Medicine", "Emergency Service", and "Emergency Treatment". After removal of duplicates, 754 articles were identified. After initial screening of titles and abstracts, 69full text articles were carefully reviewed and 34 articles were ultimately included in the study based on inclusion and exclusion criteria. The articles were grouped into four main categories: decision aids and outcome predictors, electrical cardioversion-based protocols, antiarrhythmic-based protocols, and general management protocols.Conclusion: This systematic review is the first study to our knowledge to evaluate the optimal management of symptomatic AF/AFLin the ED with a direct impact on ED disposition. There are several viable management strategies that can result in safe discharge from the ED in the right patient population, and decision aids can be utilized to guide selection of appropriate patients for discharge.

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Ibutilide to expedite ED therapy for recent-onset atrial fibrillation flutter

Cited by 11 publications

References 33 publications

Safety and Efficiency of Calcium Channel Blockers Versus Beta‐blockers for Rate Control in Patients With Atrial Fibrillation and No Acute Underlying Medical Illness

Safety and Efficiency of Calcium Channel Blockers Versus Beta‐blockers for Rate Control in Patients With Atrial Fibrillation and No Acute Underlying Medical Illness

Emergency Department Use of Intravenous Procainamide for Patients with Acute Atrial Fibrillation or Flutter

Management and Disposition of Atrial Fibrillation in the Emergency Department: A Systematic Review

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