(Circulation. 1996;94:1499-1502.)
© 1996 American Heart Association, Inc.
Articles |
Ibutilide and the Treatment of Atrial Arrhythmias
A New Drug-Almost Unheralded-Is Now Available to US Physicians
Vanderbilt University School of Medicine, Departments of Medicine and Pharmacology, Nashville, Tenn.
Correspondence to Dan M. Roden, MD, Director, Division of Clinical Pharmacology, Vanderbilt University School of Medicine, 532C Medical Research Bldg-I, Nashville, TN 37232-6602.
Key Words: Editorials • atrial flutter • fibrillation • arrhythmia • drugs
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Introduction |
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The concept that drugs that prolong ventricular repolarization, and hence refractoriness, might be effective antiarrhythmics was first advanced over 25 years ago.1 Agents such as quinidine, sotalol, and amiodarone all prolong refractory periods in cardiac tissue at least partially through this mechanism, often termed a "class III" action. However, since these compounds also exert other important pharmacological actions, such as conduction slowing (by depression of sodium current or other mechanisms) or antiadrenergic effects, it has not been possible to establish that action potential prolongation is in fact antiarrhythmic in human subjects. The development of drugs whose sole pharmacological action is to prolong the cardiac action potential has now provided a tool to address this question, and indeed small clinical trials testing these agents do indicate antiarrhythmic activity.2 3 In this issue of Circulation, Stambler and colleagues4 report the results of a large, placebo-controlled, blinded trial of ibutilide, a "pure" action potential–prolonging agent, in patients with atrial fibrillation and flutter. The demonstration that ibutilide infusion can terminate atrial fibrillation or flutter was pivotal in the recent decision by the Food and Drug Administration (FDA) to approve marketing of the drug for this indication. Thus, ibutilide is the first of the "pure" action potential–prolonging agents to be available to practicing physicians.
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Study Results |
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The patients reported by Stambler and colleagues represent a rather typical group of patients for whom conversion to sinus rhythm might be contemplated: 75% had a history of heart disease other than atrial fibrillation or flutter, 83% had an enlarged left
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