Ibutilide for cardioversion of atrial flutter on old patients

Pettinati G., De Santis F., Marzo A., Martignano R., Ieva M.

Division of Cardiology – “F. Ferrari” Hospital - Casarano (Italy)

Mediterranean Journal Pacing and Electrophysiology.

Volume 8 n. 1 -2 January - June 2006

Ibutilide (Ib.) is a class III antiarrhthmic drug used for the cardioversion of atrial flutter. Ib. prolongs action potential duration by activating a sodium slow inward current and blocking the rapidly component of delayed rectifier  potassium current. Ib. cause long QT and can cause polimorphyc ventricular tachicardia.

Aim of study: was to assess efficacy and safety of the Ib. for cardioversion of atrial flutter on old patients

Materials and metodhs: We studied 200 p. (83 M., 127 F.) on two groups: Group I: 80 p. (35 males) age < 65 y (mean age 59± 5y (range 32 – 65); Group II: 120 p. (48 males) age > 65 y (mean age 73±8 y (range 66-94 y) affected by atrial flutter, mean duration 6±5 days. Structural heart disease was evident on 120 p (70%), justly assigned on both groups.

All patients were administered 1 mg intravenous Ibutilide on 10 minutes and a second egual dose can be given if the arrhytmia has no terminated after 30 minutes, on EKG continous monitoring.

We considered responders patients with sinusal rhytm (SR)  within 2 hour from infusion onset.

Results: we obtained S.R. on 153/200 p. (76,5%) exactly 62/80 (77,5%) on Group I and 91/120 (75,8%) of Group II, mean time of cardioversion 36±10 minutes (range 5-60) on both group. Pro arrhythmic side effect was 15/200 (7,5%) We assessed exactly 6/200 sustained torsade de point (3%) and 9/200 monomorphic non sustained ventricular tachicardya (4,5%). Torsade de point was 2/80 (2,5%) on Group I and 4/120 (3,3%) on Group II. Monomorphic ventricular tachicardya., was 3/80 (3,0%) on Group I and 6/120 (5%) II (N.S.). None patient died.

Conclusion: Ibutilide is a efficace and safe drug for cardioversion of atrial flutter on young and old patients.