title: Termination of recent-onset atrial fibrillation/flutter in the emergency department: a sequential approach with intravenous ibutilide and external electrical cardioversion.
abstract: Safety and effectiveness are the goals in treating patients with arrhythmias. In an open prospective study, we observed the efficacy and safety of up to 2 mg intravenous ibutilide, a new class III antiarrhythmic agent in haemodynamically stable patients presenting in the emergency department (ED) with symptoms of recent-onset (<48 h) atrial fibrillation/flutter. Arrhythmia termination within 90 min, haemodynamic parameters and proarrhythmic effects were assessed. Non-responders to the ibutilide infusion underwent external electrical cardioversion. We included 51 patients. In 31 patients therapeutic intervention with intravenous ibutilide was successful within 90 min (61%). In another seven patients conversion to sinus rhythm occurred after 90 min without any other intervention (14%). Blood pressure remained stable and no relevant proarrhythmic effects were observed. The 13 patients who did not respond to ibutilide treatment underwent successful external electrical cardioversion. The overall conversion rate was 100%. Forty-seven patients (92%) were discharged within a median of 9 h and managed as outpatients. In conclusion, in haemodynamically stable patients with recent-onset atrial fibrillation/flutter intravenous ibutilide and external electrical cardioversion for conversion to sinus rhythm turned out to be effective and safe. The short duration of admission makes this strategy attractive for use in the ED.
authors.affiliation: Department of Emergency Medicine, Vienna General Hospital, University of Vienna, Medical School, Austria. hans.domanovits@akh-wien.ac.at
authors.forename: H
authors.initials: H
authors.lastname: Domanovits
authors.forename: M
authors.initials: M
authors.lastname: Schillinger
authors.forename: J
authors.initials: J
authors.lastname: Thoennissen
authors.forename: M
authors.initials: M
authors.lastname: Nikfardjam
authors.forename: K
authors.initials: K
authors.lastname: Janata
authors.forename: M
authors.initials: M
authors.lastname: Brunner
authors.forename: A N
authors.initials: AN
authors.lastname: Laggner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000628:therapy*; D001282:Atrial Flutter / Q000628:therapy*; D003131:Combined Modality Therapy; D004554:Electric Countershock / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D013449:Sulfonamides / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D013449:Sulfonamides; C067192:ibutilide