Comparison of amiodarone versus ibutilide for the prevention of immediate recurrences of atrial fibrillation during pulmonary vein isolation.
During segmental ostial ablation for pulmonary vein isolation, pulmonary vein potentials are easily identified during sinus rhythm or left atrial pacing. Therefore, maintenance of atrial fibrillation (AF) during the procedure is desirable. However, cardioversion is occasionally followed by an immediate recurrence of AF. This study compared the efficacy of ibutilide and amiodarone in preventing immediate recurrences of AF in patients who underwent pulmonary vein isolation. The subjects of this study were 25 patients (mean age 56 +/- 10 years) who underwent pulmonary vein isolation for AF who had an immediate recurrence of AF within 60 seconds after 2 transthoracic cardioversions. The patients were randomized to receive an infusion of either 300 mg of amiodarone over 10 minutes or 1 mg of ibutilide over 5 minutes. Cardioversion was repeated 15 minutes after the drug infusion. If immediate recurrences of AF occurred 2 more times, the alternative study drug was administered, and cardioversion was repeated. Immediate recurrences of AF were suppressed by amiodarone in 8 of 10 patients (80%), and by ibutilide in 9 of 15 patients (60%, p = 0.4). After crossover, immediate recurrence of AF was suppressed in 2 of 6 patients (33%) by amiodarone, and in 1 of 2 patients (50%) by ibutilide (p = 0.6). Ibutilide and amiodarone, when used alone or in combination, prevented immediate recurrences of AF in 20 of 25 patients (80%). There were no adverse drug effects. Ibutilide and amiodarone were equally effective in suppressing immediate recurrences of AF. Overall, immediate recurrences of AF can be prevented by amiodarone and/or ibutilide in 80% of patients.
Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA. oralh@umich.edu
Hakan
H
Oral
Mehmet
M
Ozaydin
Hiroshi
H
Tada
Aman
A
Chugh
Sohail
S
Hassan
Christoph
C
Scharf
Steve W K
SW
Lai
Radmira
R
Greenstein
Frank
F
Pelosi
Bradley P
BP
Knight
S Adam
SA
Strickberger
Fred
F
Morady
D000368:Aged; D000638:Amiodarone / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000517:prevention & control*; D017115:Catheter Ablation; D018592:Cross-Over Studies; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D013449:Sulfonamides / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; D013449:Sulfonamides; C067192:ibutilide; D000638:Amiodarone