Key result
Ibutilide is an effective alternative to electrical cardioversion for recent-onset atrial fibrillation and flutter, achieving conversion rates up to 75% to 80%, though it carries a 4% risk of torsade de pointes.
Why the study?
Does ibutilide improve conversion to sinus rhythm in patients with atrial fibrillation and flutter?
Does ibutilide improve conversion to sinus rhythm in patients with atrial fibrillation and flutter?
Ibutilide is a highly effective agent for the chemical cardioversion of atrial flutter and fibrillation, particularly in recent-onset cases and as a facilitator for electrical cardioversion, provided patients are closely monitored for proarrhythmia.
Supports ibutilide consideration for recent-onset AF/AFL under monitoring; leaves open need for RCTs versus electrical cardioversion.
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.
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Nair et al. (2011) conducted a review in Atrial fibrillation and flutter. Ibutilide vs. Electrical cardioversion, placebo, or other antiarrhythmics was evaluated. Ibutilide is an effective alternative to electrical cardioversion for recent-onset atrial fibrillation and flutter, achieving conversion rates up to 75% to 80%, though it carries a 4% risk of torsade de pointes.
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