Ibutilide to expedite ED therapy for recent-onset atrial fibrillation flutter.
OBJECTIVE
Ibutilide is a type III antiarrhythmic agent approved for the pharmacologic conversion of atrial fibrillation (AF) and atrial flutter (AFl). Previous studies conducted outside the ED setting have demonstrated conversion rates of 60% to 80%. This response has been highest in patients with recent-onset AF-AFl. These observations and the 4-hour half-life of ibutilide suggest that it may be an excellent drug with which to treat AF-AFl in the ED. The purpose of the study was to examine the efficacy and safety of ibutilide in terminating AF-AFl in patients who present to the ED with symptoms of less than 3 days' duration, neither angina nor heart failure, and no comorbid conditions that require admission.


METHODS
Among 36 enrolled patients, the admission electrocardiogram demonstrated AF in 26 and AFl in 10. Ibutilide 1 mg was administered intravenously for 10 minutes. If sinus rhythm was not present 10 minutes after the infusion concluded, a second infusion of 1 mg was given. Successful conversion was defined as restoration of sinus rhythm within 1 hour after the last dose of ibutilide.


RESULTS
Sixteen (61.5%) of 26 patients with AF and 9 (90%) of 10 patients with AFl converted to sinus rhythm (overall conversion rate=69%). The mean time to arrhythmia termination was 19+/-9 minutes. The mean stay in the ED was 16.2 hours. No significant complications occurred.


CONCLUSIONS
We conclude that ibutilide is an excellent therapy option for restoring sinus rhythm in the ED. Its use may obviate the need for admission, avoid the risks and inconveniences of general anesthesia to perform electrical cardioversion, and reduce the ED length of stay in selected patients with recent-onset atrial arrhythmias.
Mountantonakis
Stavros E
SE
Internal Medicine and Cardiology Department, Livadia General Hospital, 32100 Livadia, Greece, and Internal Medicine and Cardiology Department, Yale University/Bridgeport Hospital, Yale New Haven Health, Bridgeport, CT 06610, USA. mountas@ccf.org
Moutzouris
Dimitrios A
DA
Tiu
Ramon V
RV
Papaioannou
Georgios N
GN
McPherson
Craig A
CA
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D001282:Atrial Flutter / Q000188:drug therapy*; D004636:Emergency Service, Hospital; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D007262:Infusions, Intravenous; D007902:Length of Stay; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use; D011446:Prospective Studies; D013449:Sulfonamides / Q000009:adverse effects / Q000627:therapeutic use*
D000889:Anti-Arrhythmia Agents; D013449:Sulfonamides; C067192:ibutilide; D008790:Metoprolol