Ibutilide for pharmacological cardioversion of atrial flutter

Introduction

Ibutilide an anti-arrhythmic drug (Vaughn Wiliams Classification Type III) is used to support the cardioversion of atrial fibrillation and atrial flutter since some years yet. In some countries ibutilide is also used as an emergency treatment for the pharmacological cardioversion of new arised atrial flutter instead of electroversion. In this prospective study the effectiveness and safety of this emergency treatment were investigated.

Methods

We included all patients with atrial flutter seen in the emergency department. All patients received a treatment with 1.0 mg ibutilide infusion over 10 min. During this period monitoring of heart rate and blood pressure was performed. Later on a telemetric observation of ECG was performed over a period of 24 hours.

Results

The procedure was performed in seven patients with a mean age of 62 ± 12.7 (SD) years. At admission the atrial flutter was persistent meanly for 5 ± 10.1 days (range 1–28 days). The mean size of the left atrium was 44 ± 4.2 mm (range 40–49 mm). In four patients a coronary heart disease was diagnosed. In five patients a stable sinus-rhythm after solitary treatment with ibutilide was recorded. Electroversion after the ibutilide infusion had to be performed in two patients to achieve a stable sinus-rhythm after recurrent atrial flutter. No complications, especially no ventricular tachycardia, occurred during the observation period. In all patients a stable sinus-rhythm could be recorded.

Conclusion

In patients with atrial flutter a pharmacological cardioversion with ibutilide should be performed. Also in patients with chronically atrial flutter and/or dilated left atrium the pharmacological cardioversion is promising a safe and minimally invasive alternative to electroversion.