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Cardioversion of atrial fibrillation with ibutilide: when is it most effective?
Mithilesh Kumar Das1, Kuruvilla Cheriparambil, Ashwini Bedi
1Division of Cardiology (Starr4), New York Presbyterian Hospital-Cornell University Medical College, New York 10021, USA. mithileshdas@hotmail.com
Insights
Ibutilide effectively converts recent-onset atrial fibrillation (AF) to sinus rhythm, particularly in patients with coronary artery disease (CAD) and without mitral valve disease (MVD) or enlarged left atrium. This finding aids in selecting patients for successful AF cardioversion.
Area of Science:
- Cardiology
- Electrophysiology
- Pharmacology
Background:
- Atrial fibrillation (AF) affects a significant portion of the elderly population, posing substantial public health challenges.
- Prevalence increases with age, with millions affected in the US and considerable healthcare costs.
- Understanding predictors for successful treatment is crucial for managing this common arrhythmia.
Purpose of the Study:
- To identify clinical and echocardiographic factors predicting successful cardioversion of recent-onset atrial fibrillation (AF) using ibutilide.
- To evaluate the efficacy of ibutilide in converting AF lasting 24 hours or longer.
Main Methods:
- A study of 101 patients with recent-onset AF (>24 hours) treated with ibutilide.
- Analysis of demographic, clinical, and echocardiographic parameters to determine conversion rates.
- Comparison of conversion success based on specific patient characteristics like left atrial size, mitral valve disease, and coronary artery disease.
Main Results:
- 55% of patients (56/101) converted to sinus rhythm.
- Factors like age, hypertension, diabetes, heart failure, and prior rate control medication did not significantly impact conversion rates.
- Significantly higher conversion rates were observed in patients without mitral valve disease (82.5%) or enlarged left atrium (30%), and especially in those without both (85%).
- Patients with coronary artery disease (CAD) showed a greater response to ibutilide (77%) compared to those without CAD (46%).
Conclusions:
- Ibutilide is most effective for cardioversion in specific patient subgroups.
- Patients with coronary artery disease (CAD) and those without mitral valve disease (MVD) and/or a markedly enlarged left atrium are ideal candidates for ibutilide therapy.
- These findings help refine patient selection for successful ibutilide-based AF cardioversion.
Background:
Atrial fibrillation (AF) is found in 1% of persons above the age of 60 years. More than 5% of the population older than 69 years and about 14% of octogenarians are at risk for this arrhythmia. It is estimated that 1.5 to 3 million persons in the United States alone suffer from AF. The public health implications and attendant morbidity are a significant drain on our health care system.
Hypothesis:
The purpose of this study was to determine the clinical and echocardiographic predictors of success in converting AF of > or = 24 h duration.
Methods:
Demographic and clinical and echocardiographic parameters of 101 patients with recent onset AF (> 24 h) who received ibutilide were studied.
Results:
Of 101 patients, 56 (55%) converted to sinus rhythm. Age, gender, hypertension, diabetes mellitus, left ventricular ejection fraction (< or = 35%), congestive heart failure, and previous medication for rate control had no significant effect on the conversion rate. Conversion rate was only 30% (9/30 patients) in the presence of an enlarged left atrium (LA > or = 5 cm) and 37.7% (23/61 patients) in the presence of mitral valve disease (MVD), whereas the conversion rate was 82.5% (33/40 patients) in the absence of MVD and 85% (29/34 patients) in the absence of both enlarged LA and MVD (p = <0.001). Patients with coronary artery disease (CAD) also exhibited a significantly greater response to ibutilide than patients without CAD (77 vs. 46%, p-value 0.005).
Conclusion:
As a therapy for cardioversion of AF, ibutilide is most effective in a selected subgroup patients, such as in patients with CAD and in patients without MVD and/or markedly enlarged left atrium.