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      Ibutilide with magnesium for conversion of atrial fibrillation or flutter in rheumatic heart disease patients : Ibutilide with magnesium for chemical cardioversion of atrial fibrillation or flutter

      research-article
      a , a , a , a , b , a , a , a ,
      Indian Heart Journal
      Elsevier
      Atrial fibrillation, Atrial flutter, Rheumatic heart disease, Structural heart disease, Ibutilide, Magnesium, Cardioversion, AF, Atrial fibrillation, AFl, Atrial flutter, AUC, Area under the curve, AR, Aortic regurgitation, AV, Atrio-ventricular, BMV, Balloon mitral valvotomy, DC, Direct-current, ECG, Electrocardiogram, HR, Heart rate, ICU, Intensive care unit, I.V., Intra-venous, LA, Left atrium, Mg++, Magnesium, MG, Mean gradient, MVA, Mitral valve area, MR, Mitral regurgitation, MS, Mitral stenosis, MVD, Mitral valve disease, NYHA, New York heart association, PIRR, Post injection rhythm reversal, QTc, Corrected QT interval, RHD, Rheumatic heart disease, ROC, Receiver operating characteristic, SPSS, Statistical product and service solutions, TDS, Ter die sumendus (three times per day), VT, Ventricular tachycardia

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          Abstract

          Background

          Data on adjunctive use of magnesium with ibutilide for conversion of persistent rheumatic atrial fibrillation and flutter to sinus rhythm is lacking.

          Aim

          We aimed to study the efficacy of adjunctive supplementation of intravenous magnesium with ibutilide for conversion of persistent rheumatic atrial fibrillation and flutter to sinus rhythm and to define a definite level of serum magnesium which leads to significant increase in rates of such conversion.

          Methods and results

          This was a prospective study including 33 Rheumatic heart disease patients (13 males and 20 females) with mean age of 49.27 ± 11.4 years and persistent AF or AFl. All patients received intravenous magnesium to raise serum magnesium level in range of 4 mg/dl to 4.5 mg/dl prior to administration of Ibutilide. 25 out of 33 (76%) patients converted to sinus rhythm. Upon univariate analysis, presence of background beta blocker therapy, serum potassium and magnesium at time of Ibutilide injection were found to have significant relation with conversion to sinus rhythm. Upon multivariate analysis serum magnesium level at the time of Ibutilide injection was found to have significant contribution on post injection rhythm reversal ( p-value = 0.006).

          The level of magnesium at 3.8 mg/dl was found to have maximum sensitivity of 96% and specificity of 62.5% for conversion to sinus rhythm by ibutilide with magnesium ( p-value< 0.05).

          Conclusions

          Ibutilide is highly effective in cardioversion of persistent rheumatic atrial fibrillation/flutter patients. Raising Serum Magnesium levels above 3.8 mg/dl significantly improves efficacy of ibutilide.

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          Most cited references19

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          2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society.

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            Preoperative amiodarone as prophylaxis against atrial fibrillation after heart surgery.

            Atrial fibrillation occurs commonly after open-heart surgery and may delay hospital discharge. The purpose of this study was to assess the use of preoperative amiodarone as prophylaxis against atrial fibrillation after cardiac surgery. In this double-blind, randomized study, 124 patients were given either oral amiodarone (64 patients) or placebo (60 patients) for a minimum of seven days before elective cardiac surgery. Therapy consisted of 600 mg of amiodarone per day for seven days, then 200 mg per day until the day of discharge from the hospital. The mean (+/-SD) preoperative total dose of amiodarone was 4.8+/-0.96 g over a period of 13+/-7 days. Postoperative atrial fibrillation occurred in 16 of the 64 patients in the amiodarone group (25 percent) and 32 of the 60 patients in the placebo group (53 percent) (P=0.003). Patients in the amiodarone group were hospitalized for significantly fewer days than were patients in the placebo group (6.5+/-2.6 vs. 7.9+/-4.3 days, P=0.04). Nonfatal postoperative complications occurred in eight amiodarone-treated patients (12 percent) and in six patients receiving placebo (10 percent, P=0.78). Fatal postoperative complications occurred in three patients who received amiodarone (5 percent) and in two who received placebo (3 percent, P= 1.00). Total hospitalization costs were significantly less for the amiodarone group than for the placebo group ($18,375+/-$13,863 vs. $26,491+/-$23,837, P=0.03). Preoperative oral amiodarone in patients undergoing complex cardiac surgery is well tolerated and significantly reduces the incidence of postoperative atrial fibrillation and the duration and cost of hospitalization.
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              Prevalence and predictors of atrial fibrillation in rheumatic valvular heart disease.

              The highest frequency of AF in RHD occurs in those with mitral stenosis, mitral regurgitation, and tricuspid regurgitation in combination. AF, while occurring in 29% of patients with isolated mitral stenosis and in 16% with isolated mitral regurgitation, is an infrequent finding (1%) in patients with aortic valvular disease. Left atrial diameter by univariate analysis, and age and left atrial diameter by multivariate analysis have been shown to be the most important parameters to determine the occurrence of AF in patients with RHD.
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                Author and article information

                Contributors
                Journal
                Indian Heart J
                Indian Heart J
                Indian Heart Journal
                Elsevier
                0019-4832
                2213-3763
                Jul-Aug 2020
                15 July 2020
                : 72
                : 4
                : 283-288
                Affiliations
                [a ]Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Mawdiangdiang, Shillong, Meghalaya, India
                [b ]Department of Community Medicine, Al-Falah School of Medical Science & Research Centre, Dhauj, Faridabad, Haryana, India
                Author notes
                []Corresponding author. Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Mawdiangdiang, Shillong, Meghalaya, India. animesh.shillong@ 123456gmail.com
                Article
                S0019-4832(20)30153-X
                10.1016/j.ihj.2020.07.008
                7474117
                32861384
                f9fe2648-33f4-4d1c-a772-aed1c382f0fb
                © 2020 Cardiological Society of India. Published by Elsevier B.V.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 19 April 2020
                : 7 July 2020
                Categories
                Original Article

                atrial fibrillation,atrial flutter,rheumatic heart disease,structural heart disease,ibutilide,magnesium,cardioversion,af, atrial fibrillation,afl, atrial flutter,auc, area under the curve,ar, aortic regurgitation,av, atrio-ventricular,bmv, balloon mitral valvotomy,dc, direct-current,ecg, electrocardiogram,hr, heart rate,icu, intensive care unit,i.v., intra-venous,la, left atrium,mg++, magnesium,mg, mean gradient,mva, mitral valve area,mr, mitral regurgitation,ms, mitral stenosis,mvd, mitral valve disease,nyha, new york heart association,pirr, post injection rhythm reversal,qtc, corrected qt interval,rhd, rheumatic heart disease,roc, receiver operating characteristic,spss, statistical product and service solutions,tds, ter die sumendus (three times per day),vt, ventricular tachycardia

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