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June 17, 1999New England Journal of MedicineOpen Access

Facilitating Transthoracic Cardioversion of Atrial Fibrillation with Ibutilide Pretreatment

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Why the study?

Does pretreatment with 1 mg of ibutilide improve conversion to sinus rhythm in patients undergoing transthoracic cardioversion for atrial fibrillation?

Population

100 patients with atrial fibrillation for a mean of 117+/-201 days

Comparison

Pretreatment with 1 mg of ibutilide prior to… vs Transthoracic cardioversion without ibutilide…

Design

RCT, randomly assigned

Follow-up

six months

Authors

HOHakan OralElectrophysiologyJSJoseph SouzaPikeville Medical CenterGMGregory F. MichaudElectrophysiology

Discussion

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Implication

Supports ibutilide pretreatment before AF cardioversion; extends evidence for adjunctive facilitation of electrical restoration in randomized settings.

Structured PICO

Does pretreatment with 1 mg of ibutilide improve conversion to sinus rhythm in patients undergoing transthoracic cardioversion for atrial fibrillation?

P
Population
100 patients with atrial fibrillation for a mean of 117+/-201 days
I
Intervention
Pretreatment with 1 mg of ibutilide prior to transthoracic cardioversion (step-up protocol: 50, 100, 200, 300, and 360 J)
C
Comparator
Transthoracic cardioversion without ibutilide pretreatment
O
Outcome
Conversion to sinus rhythm

Pretreatment with 1 mg of ibutilide significantly enhances the success rate of transthoracic cardioversion for atrial fibrillation and reduces the energy required, though it carries a risk of polymorphic VT in patients with very low ejection fractions.

Cite This Study

Oral et al. (1999) studied this question.

synapsesocial.com/papers/6a1eb841989adebfe89a7ff1https://doi.org/10.1056/nejm199906173402401

Topics

Persistent AF managementAtrial fibrillationVentricular arrhythmiasAnticoagulation in AFAF ablation outcomes
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Efficacy and Safety of Repeated Intravenous Doses of Ibutilide for Rapid Conversion of Atrial Flutter or Fibrillation1996 · 489 citations
  2. 2Amiodarone-Induced Refractoriness to Cardioversion1984 · 89 citations
  3. 3Antiarrhythmic Actions of Intravenous Ibutilide Compared With Procainamide During Human Atrial Flutter and Fibrillation1997 · 159 citations
  4. 4Ibutilide1998 · 156 citations
  5. 5A Comparison of Transvenous Atrial Defibrillation of Acute and Chronic Atrial Fibrillation and the Effect of Intravenous Sotalol on Human Atrial Defibrillation Threshold1997 · 73 citations