Female preponderance in ibutilide-induced torsade de pointes.

Abstract

OBJECTIVE:

Ibutilide, a class III antiarrhythmic agent used for pharmacological cardioversion of atrial arrhythmias, has a potential to cause QT-interval prolongation and torsade de pointes. Purpose of this study was to determine whether women are more prone to develop ibutilide-induced torsade de pointes.

METHODS:

All clinical trials, cases, case series, and related articles in English-language in addition to 51 patients from our institution on the subject were examined.

RESULTS:

In a database derived from 23 reports in literature and from our institution, 1720 patients received ibutilide for cardioversion of atrial arrhythmias. Only in 87% (n=1492) patients, data were reported whether or not ibutilide caused torsade de pointes. The overall incidence of torsade de pointes was 3.9% (n=58) patients. Data on sex distribution of ibutilide-induced torsade de pointes was available in 73% (n=1096) patients. Torsade de pointes developed in 17 (5.6%) of 304 women and 24 (3%) of 792 men (P=0.05). It occurred during or within 45 min after completion of the infusion of ibutilide. Treatment instituted was with intravenous magnesium sulfate alone in 14% (n=8) patients, magnesium sulfate plus lidocaine in 5% (n=3) patients, magnesium sulfate with electrical cardioversion in 17% (n=10) patients, electrical cardioversion alone in 19% (n=11) patients, and precordial thump in 3% (n=2) patients. In 41% (n=24) of patients who developed torsade de pointes, it resolved without treatment. There were no reported deaths secondary to torsade de pointes associated with ibutilide infusion.

CONCLUSION:

Incidence of ibutilide-induced torsade de pointes is higher in women than in men. Greater caution must be observed while using ibutilide in women.

• Authors: Ramesh M Gowda, Ijaz A Khan, Gopikrishna Punukollu, Balendu C Vasavada, Terrence J Sacchi, Sabrina L Wilbur
• Journal: International journal of cardiology (Int J Cardiol) Vol. 95 Issue 2-3 Pg. 219-22 (Jun 2004) ISSN: 0167-5273 [Print] Netherlands
• PMID: 15193823 (Publication Type: Comparative Study, Journal Article, Review)

Chemical References

• Anti-Arrhythmia Agents
• Sulfonamides
• ibutilide

Topics

• Anti-Arrhythmia Agents (adverse effects)
• Atrial Fibrillation (drug therapy)
• Female
• Humans
• Incidence
• Male
• Sex Distribution
• Sulfonamides (adverse effects)
• Torsades de Pointes (chemically induced, epidemiology)