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Body Weight Counts-Cardioversion with Vernakalant or Ibutilide at the Emergency Department

Teresa Lindmayr1,2, Sebastian Schnaubelt1, Patrick Sulzgruber3

  • 1Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria.

Journal of Clinical Medicine
|September 9, 2022
PubMed

Insights

Pharmacological cardioversion for atrial fibrillation (AF) and atrial flutter (AFL) success is not different between weight-adapted Vernakalant and fixed-dose Ibutilide. However, increasing body weight reduces cardioversion success with fixed-dose Ibutilide.

Area of Science:

  • Cardiology
  • Pharmacology
  • Internal Medicine

Background:

  • Pharmacological cardioversion is a key treatment for atrial fibrillation (AF) and atrial flutter (AFL).
  • Dosing strategies include fixed-dose and weight-adapted approaches.
  • The impact of patient body weight on treatment efficacy remains an area of investigation.

Purpose of the Study:

  • To investigate the influence of body weight on the success of pharmacological cardioversion for AF and AFL.
  • To compare the efficacy of weight-adapted Vernakalant versus fixed-dose Ibutilide in relation to body weight.

Main Methods:

  • A prospective observational study enrolled 316 episodes of AF and AFL.
  • Patients were assigned to either the Vernakalant (n=181) or Ibutilide (n=135) treatment group.
  • Treatment efficacy was compared between the two groups.

Main Results:

  • Overall conversion to sinus rhythm was achieved in 76.3% of patients.
  • No significant difference in conversion rates was observed between Vernakalant (76.2%) and Ibutilide (76.3%) groups (p=0.991).
  • Increasing body weight was associated with decreased conversion rates in the overall population (aOR=0.69, p=0.018) and independently in the Ibutilide arm (aOR=0.55, p=0.022).

Conclusions:

  • Both Vernakalant and Ibutilide demonstrated comparable success rates for pharmacological cardioversion of AF and AFL.
  • Fixed-dose Ibutilide showed reduced treatment success with increasing body weight compared to weight-adapted Vernakalant.
  • Body weight is a significant factor influencing the effectiveness of fixed-dose cardioversion medications.
Abstract

Keywords:
atrial fibrillationbody weightcardioversionpharmacological cardioversion

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