Safety and efficacy of ibutilide in cardioversion of atrial flutter and fibrillation
Open accessAbstract
This article reviews the safety and efficacy of ibutilide for use in patients with atrial fibrillation and flutter. Ibutilide, a class III antiarrhythmic agent, is primarily used for conversion of atrial flutter and fibrillation and is a good alternative to electrical cardioversion. Ibutilide has a conversion rate of up to 75% to 80% in recent-onset atrial fibrillation and flutter; the conversion rate is higher for atrial flutter than for atrial fibrillation. It is also safe in the conversion of chronic atrial fibrillation/flutter among patients receiving oral amiodarone therapy. Ibutilide pretreatment facilitates transthoracic defibrillation and decreases the energy requirement of electrical cardioversion by both monophasic and biphasic shocks. Pretreatment with ibutilide before electrical defibrillation has a conversion rate of 100% compared with 72% with no pretreatment. Ibutilide is also safe and efficient in the treatment of atrial fibrillation in patients who have had cardiac surgery, and in accessory pathway-mediated atrial fibrillation Where the conversion rate of ibutilide is as high as 95%. There is up to a 4% risk of torsade de pointes and a 4.9% risk of monomorphic ventricular tachycardia. Hence, close monitoring in an intensive care unit setting is warranted during and at least for 4 hours after drug infusion. The anticoagulation strategy is the same as for any other mode of cardioversion.
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Ibutilide is more effective for conversion of atrial flutter than AF, whereas vernakalant is less effective in converting typical atrial flutter.
“Ibutilide is more effective for conversion of atrial flutter than AF, whereas vernakalant is less effective in converting typical atrial flutter.996,997”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [997]
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Mechanisms of Chemical Atrial Defibrillation by Flecainide and Ibutilide
Yang, P., Belardinelli, L., & Clancy, C. E. (2024) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2024.08.009 · Cited by 4 · see citing works
Class III Antiarrhythmic Drugs
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Family Practice is a Highly Complex Business
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- Authors
- Nair, M., George, L. K., & Koshy, S. K. G.
- Affiliations
- University of Oklahoma - Tulsa (US)
- University of Tennessee Health Science Center (US)
- ORCID
- Koshy, S. K. G.
- Venue
- The Journal of the American Board of Family Medicine
- Published
- 2011-01-01
- Volume
- 24
- Issue
- 1
- Pages
- 86-92
- ISSN
- 1557-2625 (ISSN-L)
- 1558-7118
- OpenAlex
- W2143440359
- Cited by
- 44
- References
- 63
- Citations by year
- 2025: 1 · 2024: 5 · 2023: 4 · 2022: 1 · 2021: 7 · 2020: 3 · 2019: 3 · 2018: 2 · 2017: 3 · 2016: 4 · 2015: 1 · 2014: 3 · 2013: 2 · 2012: 2
- FWCI
- 0.54
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of the American Board of Family Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- ibutilide, atrial fibrillation, atrial flutter, electrical cardioversion, antiarrhythmic drugs, class III antiarrhythmic agents, amiodarone, transthoracic defibrillation, postoperative atrial fibrillation, torsades de pointes, monomorphic ventricular tachycardia, drug safety, conversion rate
- MeSH terms
- Age Factors, Anti-Arrhythmia Agents, Atrial Fibrillation, Atrial Flutter, Chronic Disease, Humans, Long QT Syndrome, Postoperative Period, Sulfonamides, Drug-Related Side Effects and Adverse Reactions
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