Termination of recent-onset atrial fibrillation/flutter in the emergency department: a sequential approach with intravenous ibutilide and external electrical cardioversion
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Abstract
Safety and effectiveness are the goals in treating patients with arrhythmias. In an
open prospective study, we observed the efficacy and safety of up to 2 mg intravenous
ibutilide, a new class III antiarrhythmic agent in haemodynamically stable patients
presenting in the emergency department (ED) with symptoms of recent-onset (<48 h)
atrial fibrillation/flutter. Arrhythmia termination within 90 min, haemodynamic parameters
and proarrhythmic effects were assessed. Non-responders to the ibutilide infusion
underwent external electrical cardioversion. We included 51 patients. In 31 patients
therapeutic intervention with intravenous ibutilide was successful within 90 min (61%).
In another seven patients conversion to sinus rhythm occurred after 90 min without
any other intervention (14%). Blood pressure remained stable and no relevant proarrhythmic
effects were observed. The 13 patients who did not respond to ibutilide treatment
underwent successful external electrical cardioversion. The overall conversion rate
was 100%. Forty-seven patients (92%) were discharged within a median of 9 h and managed
as outpatients. In conclusion, in haemodynamically stable patients with recent-onset
atrial fibrillation/flutter intravenous ibutilide and external electrical cardioversion
for conversion to sinus rhythm turned out to be effective and safe. The short duration
of admission makes this strategy attractive for use in the ED.