Ibutilide in rapid conversion of atrial flutter in octogenarians.
BACKGROUND
Atrial flutter is a common sustained atrial tachyarrhythmia for which frequency increases with age. Ibutilide is a novel class III antiarrhythmic agent used for the rapid cardioversion of atrial fibrillation or atrial flutter.


OBJECTIVE
The aim of our study was to assess the use of ibutilide in a selected population of very elderly patients (octogenarians) with recent-onset atrial flutter.


METHODS
Twenty-nine consecutive elderly patients (11 male, 18 female; mean age 83 +/- 3 years; interquartile range of 10) with recent-onset atrial flutter were included in the study; none of them had signs or symptoms of severe heart failure, angina or impaired renal or hepatic function. All patients underwent a 10-minute intravenous infusion of ibutilide (0.87 mg in 10 ml).


RESULTS
The rate of successful arrhythmia termination was 75.9% within a mean time of 31 +/- 20 minutes. No clinical variables were shown to be associated with successful cardioversion, although there was a tendency towards higher efficacy in patients with a shorter duration of arrhythmia. Two female patients (6.9%) developed torsade de pointes, requiring direct current cardioversion under general anaesthesia. Episodes of nonsustained ventricular tachycardia occurred in two other patients.


CONCLUSIONS
Ibutilide appears to be an effective and well tolerated drug for rapid conversion of recent-onset atrial flutter in octogenarian patients, and may represent a valid approach in the acute management of atrial flutter in this particular set of patients.
Antonicelli
Roberto
R
Department of Cardiology-CCU, Italian National Centre on Aging (INRCA), Ancona, Italy. r.antonicelli@incra.it
Testarmata
Paolo
P
Recanatini
Andrea
A
D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001282:Atrial Flutter / Q000188:drug therapy* / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D013449:Sulfonamides / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; D013449:Sulfonamides; C067192:ibutilide