S-112
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Pharmacologic conversion of
atrial fibrillation and atrial flutter: the role of ibutilide
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Philip T. Sager.
UCLA School of Medicine, Cardiac Electrophysiology, West Los Angeles Veterans
Administration Hospital, Los Angeles, USA
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Abstract
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Atrial fibrillation and atrial flutter commonly
termination and while this has most frequently been accomplished using direct current
cardioversion, there has recently been increased focus on the use of intravenous
antiarrhythmic drugs to restore sinus rhythm. Ibutilide is the first pure class III agent
to become clinically available and was developed to rapidly terminate atrial fibrillation
and atrial flutter by acutely prolonging the atrial action potential duration and
effective refractory period. The clinical data shows that the agent is effective in
terminating recent onset atrial fibrillation and terminating atrial flutter. It has also
shown to be effective in treating patients who have recently undergone cardiac surgery. In
addition, in randomized trials, ibutilide was more effective than IV procainamide or IV
d,l-sotalol. There is a definite risk of torsade de pointes secondary to the class III
actions of the drug, demonstrating the need for careful selection and monitoring of
patients receiving ibutilide. Such episodes of torsade de pointes were adequately managed
without sequelae. In conclusion, ibutilide provides an alternative modality to direct
current cardioversion to terminate atrial fibrillation and atrial flutter and restore
sinus rhythm.
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Key Words
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Treatment of arrhythmias - pharmacological management
ibutilide, atrial fibrillation, atrial flutter, class III drugs, pharmacologic conversion,
procainamide, dl-sotalol, risk of torsade de pointes, R
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