Ibutilide after unsuccessful electric electroversion of atrial fibrillation

Introduction

Ibutilide, an anti-arrhythmic drug (Vaughn Wiliams Classification Type III) is used to support the Cardioversion (CV) of atrial fibrillation and atrial flutter since some years yet. Under usage of ibutilide lower energy charges for electroversion and higher rates of success have been reported.

Methods

In this prospective study all patients with atrial fibrillation received, after unsuccessful synchronized electroversion with increased energy charges till 360 J, 1.0 mg ibutilide within 10 min. After that procedure a new electroversion was performed. The success-rates have been reported.

Results

The procedure was performed in 18 patients with a mean age of 62 ± 11.2 (SD) years. At admission the atrial fibrillation was persistent meanly for 333 ± 934.1 days (range 1–4000 days). The mean size of the left atrium was 48 ± 7.4 mm (range 30–60 mm). In four patients a coronary heart disease was diagnosed. In 15 patients a stable sinus-rhythm (SR) could be reported after the ibutilide infusion and further electroversion with 360 J. In two patients SR could be reported after the ibutilide infusion without any further electroversion. In one patient the atrial fibrillation was persistent although he received the therapy with ibutilide. No side-effects, especially no ventricular tachycardia, occurred.

Conclusion

In patients with atrial fibrillation and unsuccessful electroversion a new try should be performed after infusion of 1.0 mg ibutilide. Also in patients with chronically atrial fibrillation for years and/or dilated left atrium this procedure is promising a safe and minimally invasive help for a successful electroversion.