Abstract
Body: Background Ibutilide fumarate is a class III antiarrhythmic agent whose sole indication is the acute conversion of atrial fibrillation or atrial flutter to sinus rhythm. Ibutilide blocks potassium channels and activates slow inward sodium channels, which delays repolarization. These actions prolong the action potential in atrial and ventricular refractory periods, leading to arrhythmia termination. Many institutions restrict the use of ibutilide because of the potential risk of polymorphic ventricular tachycardia (PMVT). Limitations include administration only in the presence of a physician, use only in certain monitored units, or an Intensive Care Unit. Methods Over a five-year period, 238 patients, 151 male/87 female, mean age 67.1 years, received intravenous ibutilide at our institution. Ibutilide was administered in four clinical settings: Emergency Department (n=80), Intensive Care Unit (n=11), Telemetry (n=107), and the Cardiac Catheterization /Electrophysiology Laboratory (n=40). Ibutilide was administered by infusion of one milligram over 15 minutes followed by a 15 minute waiting period, the infusion was repeated. The infusion was discontinued if the patient converted to sinus rhythm. Results Conversion to sinus rhythm occurred in 59% of patients outside the cath/EP lab. The incidence of PMVT was 1.7%. Three patients had brief, non-sustained polymorphic ventricular tachycardia and one patient had a sustained PMVT. Our data suggest that ibutilide is safe and efficacious drug when ordered by experienced physicians in properly selected patients in a variety of monitored settings. Ibutilide is ordered at our institution almost exclusively by cardiac electrophysiologists and emergency physicians who routinely consult with the electrophysiologists prior to administration. No deaths occurred in our five-year series. As a result of this study, the policy at our institution is that ibutilide may be administered by nurses on telemetry units. Close Window
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