Ibutilide for rapid conversion of atrial fibrillation or flutter in a mixed critically ill patient population.

Abstract

INTRODUCTION:

Ibutilide is an intravenous class III antiarrhythmic agent that has been shown to be effective in converting acute onset atrial fibrillation/flutter in stable medical and cardio-surgical patients. Data on its use in critically ill patients are rare. The aim of this open, non-randomized, prospective trial was to assess the potential role of ibutilide for conversion of recent onset atrial fibrillation/flutter in a mixed critically ill ICU-population.

METHODS:

Twenty cardiac-surgical and 17 medical patients with acute tachycardic atrial fibrillation or flutter received up to two 10-min intravenous infusions of 1.0 mg ibutilide.

RESULTS:

The cumulative conversion efficacy of ibutilide was 56.8% (21 of 37 patients). The mean time to termination of the arrhythmia was 17.7 +/- 12.5 min (range 4 to 45 min) after the start of the first infusion. Conversion success was significantly higher in medical compared to cardiac-surgical patients (82.4 versus 35.0%, p=.0063). In a multivariate binary stepwise logistic regression analysis adjusted for age, heart rate and reduced left ventricular function, cardiac surgery remained significantly associated with a lower conversion probability (RR, .14; 95%CI, 0.02 to 0.76; p=.0190). Serious, ibutilide-induced ventricular arrhythmias developed in 3/37 patients (8.1%). Two of these 3 patients had a left ventricular ejection fraction < 20%.

CONCLUSION:

Ibutilide is an effective treatment for conversion of acute tachycardic atrial fibrillation/flutter in critically ill patients. Higher efficacy can be expected in medical than cardiac-surgical patients. Ventricular proarrhythmia, especially in patients with severely depressed left ventricular function represents the most important limitation of ibutilide treatment.

• Authors: Georg Delle Karth, Martin Schillinger, Alexander Geppert, Markus Haumer, Marianne Gwechenberger, Brigitte Meyer, Gottfried Heinz, Peter Siostrzonek
• Journal: Wiener klinische Wochenschrift (Wien Klin Wochenschr) Vol. 117 Issue 3 Pg. 92-7 (Feb 2005) ISSN: 0043-5325 [Print] Austria
• PMID: 15773423 (Publication Type: Clinical Trial, Controlled Clinical Trial, Journal Article)

Chemical References

• Anti-Arrhythmia Agents
• Sulfonamides
• ibutilide

Topics

• Aged
• Anti-Arrhythmia Agents (administration & dosage)
• Atrial Fibrillation (drug therapy, epidemiology)
• Atrial Flutter (drug therapy, epidemiology)
• Austria (epidemiology)
• Critical Care (statistics & numerical data)
• Female
• Humans
• Male
• Middle Aged
• Risk Assessment (methods)
• Risk Factors
• Sulfonamides (administration & dosage)
• Treatment Outcome