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[Efficacy and safety of ibutilide for conversion of atrial fibrillation/flutter]
Zhong Yu1, Meixiang Xiang, Changsheng Ma
1Department of Cardiology, Hangzhou First Municipal Hospital, Hangzhou 310006, China. cyq6395@sina.com
Insights
Intravenous ibutilide effectively converts recent-onset atrial fibrillation (AF) and atrial flutter (AFL) to sinus rhythm. This study found ibutilide to be a safe and faster alternative to propafenone for cardioversion.
Area of Science:
- Cardiology
- Pharmacology
Context:
- Atrial fibrillation (AF) and atrial flutter (AFL) are common arrhythmias.
- Current treatments for recent-onset AF/AFL have varying efficacy and safety profiles.
Purpose:
- To compare the efficacy and safety of intravenous ibutilide versus propafenone for cardioversion of recent-onset AF/AFL.
Summary:
- A randomized trial included 99 patients with AF/AFL, comparing intravenous ibutilide to propafenone.
- Ibutilide achieved a significantly higher conversion rate (69.4%) compared to propafenone (44.0%) and had a shorter conversion time.
- Adverse events were generally mild, with non-sustained ventricular tachycardia observed in the ibutilide group and transient hypotension/heart pause in the propafenone group.
Impact:
- Intravenous ibutilide demonstrates superior efficacy and comparable safety for cardioverting recent-onset AF/AFL.
- The findings support ibutilide as a valuable therapeutic option for managing these arrhythmias.
- Strict electrocardio-monitoring is crucial during administration.
Objective:
To investigate the efficacy and safety of intravenous ibutilide for conversion of atrial fibrillation (AF) and flutter (AFL) to sinus rhythm.
Methods:
Ninety-nine consecutive patients aged 18-75 y with AF/AFL were included. The duration of arrhythmia was <90 d (1 h-90 d) and ventricular rate was >60 beats/min. Patients were assigned randomly into two groups: 49 patients in ibutilide group received ibutilide 1 mg, then repeated if AF/AFL was not converted after 10 min; 50 patients in propafenone group received propafenone 70 mg, then repeated if AF/AFL persisted after 10 min. Two drugs were diluted by 50 ml of 5% glucose and injected intravenously within 10 min.
Results:
Ventricular rates were decreased in both groups. AF/AFL were converted in 34 of 49 patients (69.4 % ) in ibutilide group and in 22 of 50 patients (44.0 %) in propafenone group (P <0.05). The converting time of ibutilide was significantly shorter than that of propafenone [(16.79 ± 12.31) min compared with (36.92 ± 11.38)min, P <0.01]. The most serious adverse effect of ibutilide was non-sustained monomorphic ventricular tachycardia (3/49,6.12 %). Transient hypotension and heart pause were the main adverse events in patients who received propafenone, acute left heart failure occurred in one patient of propafenone group.
Conclusion:
Intravenous ibutilide is a safe and effective agent for cardioversion of recent-onset AF/AFL. Furthermore,strict processing under electrocardio-monitoring is important.
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