(Circulation. 1996;94:1613-1621.)
© 1996 American Heart Association, Inc.
Articles |
Efficacy and Safety of Repeated Intravenous Doses of Ibutilide for Rapid Conversion of Atrial Flutter or Fibrillation
the West Roxbury Veterans Administration Medical Center and Harvard Medical School (B.S.S.), West Roxbury, Mass; McGuire Veterans Administration Medical Center and Medical College of Virginia (Richmond) (M.A.W., K.A.E.); and the Pharmacia & Upjohn Company (K.T.P., L.K.W., J.T.V.), Kalamazoo, Mich.
Correspondence to Bruce S. Stambler, MD, Cardiology Section (111A), West Roxbury VA Medical Center, 1400 VFW Pkwy, West Roxbury, MA 02132.
Background Currently available antiarrhythmic drugs have limited efficacy for acute termination of atrial fibrillation and flutter, especially if the arrhythmia is not of recent onset. The purpose of this multicenter study was to determine the efficacy and safety of repeated doses of intravenous ibutilide, a class III antiarrhythmic drug, in terminating atrial fibrillation or flutter.
Methods and Results Two hundred sixty-six patients with sustained atrial fibrillation (n=133) or flutter (n=133), with an arrhythmia duration of 3 hours to 45 days, were randomized to receive up to two 10-minute infusions, separated by 10 minutes, of ibutilide (1.0 and 0.5 mg or 1.0 and 1.0 mg) or placebo. The conversion rate was 47% after ibutilide and 2% after placebo (P<.0001). The two ibutilide dosing regimens did not differ in conversion efficacy (44% versus 49%). Efficacy was higher in atrial flutter than fibrillation (63% versus 31%, P<.0001). In atrial fibrillation but not flutter, conversion rates were higher in patients with a shorter arrhythmia duration or a normal left atrial size. Arrhythmia termination occurred a mean of 27 minutes after start of the infusion. Of 180 ibutilide-treated patients, 15 (8.3%) developed polymorphic ventricular tachycardia during or soon after the infusion. The arrhythmia required cardioversion in 3 patients (1.7%) and was nonsustained in 12 patients (6.7%).
Conclusions Intravenous ibutilide given in repeated doses is effective in rapidly terminating atrial fibrillation and flutter and under monitored conditions is an alternative to current cardioversion options.
Key Words: atrial flutter • ibutilide • fibrillation • antiarrhythmia agents • arrhythmia
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G. Cotter, A. Blatt, E. Kaluski, E. Metzkor-Cotter, M. Koren, I. Litinski, R. Simantov, Y. Moshkovitz, R. Zaidenstein, E. Peleg, et al. Conversion of recent onset paroxysmal atrial fibrillation to normal sinus rhythm: the effect of no treatment and high-dose amiodarone. A randomized, placebo-controlled study Eur. Heart J., December 2, 1999; 20(24): 1833 - 1842. [Abstract] [PDF]
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A. M. J. Choy, D. Darbar, S. Dell'Orto, and D. M. Roden Exaggerated QT prolongation after cardioversion of atrial fibrillation J. Am. Coll. Cardiol., August 1, 1999; 34(2): 396 - 401. [Abstract] [Full Text] [PDF]
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J. T. VanderLugt, T. Mattioni, S. Denker, D. Torchiana, T. Ahern, L. K. Wakefield, K. T. Perry, and P. R. Kowey Efficacy and Safety of Ibutilide Fumarate for the Conversion of Atrial Arrhythmias After Cardiac Surgery Circulation, July 27, 1999; 100(4): 369 - 375. [Abstract] [Full Text] [PDF]
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H. Oral, J. J. Souza, G. F. Michaud, B. P. Knight, R. Goyal, S. A. Strickberger, and F. Morady Facilitating Transthoracic Cardioversion of Atrial Fibrillation with Ibutilide Pretreatment N. Engl. J. Med., June 17, 1999; 340(24): 1849 - 1854. [Abstract] [Full Text] [PDF]
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P. J. Podrid Redefining the Role of Antiarrhythmic Drugs N. Engl. J. Med., June 17, 1999; 340(24): 1910 - 1912. [Full Text]
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M A Vos, S R Golitsyn, K Stangl, M Y Ruda, L Van Wijk, J D Harry, K T Perry, P Touboul, G Steinbeck, and H J J Wellens Superiority of ibutilide (a new class III agent) over DL-sotalol in converting atrial flutter and atrial fibrillation Heart, June 1, 1998; 79(6): 568 - 575. [Abstract] [Full Text]
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C.-T. Tai, S.-A. Chen, A.-N. Feng, W.-C. Yu, Y.-J. Chen, and M.-S. Chang Electropharmacologic Effects of Class I and Class III Antiarrhythmia Drugs on Typical Atrial Flutter : Insights Into the Mechanism of Termination Circulation, May 19, 1998; 97(19): 1935 - 1945. [Abstract] [Full Text] [PDF]
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K. T. Murray Ibutilide Circulation, February 10, 1998; 97(5): 493 - 497. [Full Text] [PDF]
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B. S. Stambler, M. A. Wood, and K. A. Ellenbogen Antiarrhythmic Actions of Intravenous Ibutilide Compared With Procainamide During Human Atrial Flutter and Fibrillation : Electrophysiological Determinants of Enhanced Conversion Efficacy Circulation, December 16, 1997; 96(12): 4298 - 4306. [Abstract] [Full Text]
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C.-T. Tai, S.-A. Chen, C.-E. Chiang, S.-H. Lee, K.-C. Ueng, Z.-C. Wen, J.-L. Huang, Y.-J. Chen, W.-C. Yu, A.-N. Feng, et al. Characterization of Low Right Atrial Isthmus as the Slow Conduction Zone and Pharmacological Target in Typical Atrial Flutter Circulation, October 21, 1997; 96(8): 2601 - 2611. [Abstract] [Full Text]
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T. Yamashita, Y. Murakawa, K. Sezaki, M. Inoue, N. Hayami, Y. Shuzui, and M. Omata Circadian Variation of Paroxysmal Atrial Fibrillation Circulation, September 2, 1997; 96(5): 1537 - 1541. [Abstract] [Full Text]
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D. Gallik, J. Altamirano, and B. N. Singh Review : Restoring Sinus Rhythm in Patients with Atrial Flutter and Fibrillation: Pharmacologic or Electrical Cardioversion? Journal of Cardiovascular Pharmacology and Therapeutics, January 1, 1997; 2(2): 135 - 144. [Abstract] [PDF]
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D. M. Roden Ibutilide and the Treatment of Atrial Arrhythmias: A New Drug-Almost Unheralded-Is Now Available to US Physicians Circulation, October 1, 1996; 94(7): 1499 - 1502. [Full Text]
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