EFFICACY OF IBUTILIDE IN THE RAPID CONVERSION OF ACUTE ATRIAL FIBRILLATION IN TRAUMA AND NONCARDIAC SURGICAL PATIENTS

Abstract

SESSION TITLE: Critical Care 1 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: New onset atrial fibrillation/flutter (AF) is a known complication of trauma and non-cardiac post-surgical patients. Ibutilide is a class-III antiarrhythmic that has been extensively studied in both medical and post-cardiac surgical patients for rapid conversion of acute AF. To date, there has been no study that examines the use of this drug in trauma and non-cardiac surgical populations. The goal of the study is to examine the efficacy and safety of this agent in the above-described patient population. METHODS: A retrospective chart review was conducted in the pharmacy database to identify patients who received ibutilide between May 2002 to Jan 2017; a total of 158 patients met inclusion criteria. Data included demographics, independent risk factors for AF, pretreatment with magnesium sulfate, conversion success, and complications. A standard intravenously dose of ibutilide was administered, repeated once if immediate conversion failed, with cardioversion considered successful if occurring within 24 hours. Patients were monitored per protocol in ICU for QT prolongation, Torsades de pointes, and hypotension. Chi-square analysis and T-test was conducted to identify factors associated with successful conversion. RESULTS: Among the 158 patients who received ibutilide, more than half were males (63.9%, n=101), and the average age was 62.4 (SD=17.2)years. Patients were evenly distributed between surgical (33.5%, n=53), trauma (31.0%, n=49), and medical (35.4%, n=56) groups. The average number of risk factors per patient was 1.2, with HTN being the most common risk factor. COPD, HTN, and DM had higher conversion rates when compared to CAD and CHF. The overall successful conversion rate was 72.2% (n=114) and the overall mortality was 27.7% (n=36; no mortality was drug-related). There was a higher conversion rate in the trauma subgroup. One person experienced Torsades de pointes and had to be electrically cardioverted. Magnesium sulfate was associated with increased successful conversion rate (75% vs 65.4%, p=0.0049) and also protection against Torsades. CONCLUSIONS: These results are comparable to previously published data on cardiac surgical and medical patients. This study demonstrates that ibutilide is a safe and effective medication for conversion of new-onset atrial fibrillation in trauma, surgical and nonsurgical patients. CLINICAL IMPLICATIONS: Ibutilide is a safe and effective drug for the rapid conversion of acute AF in trauma and non-cardiac surgical patients, with CHF and CAD predicting lower conversion rates. DISCLOSURES: No relevant relationships by Esther Bae, source=Web Response No relevant relationships by Nguyen Dao, source=Web Response No relevant relationships by Fanglong Dong, source=Web Response No relevant relationships by Yamuna GnanaDev, source=Web Response No relevant relationships by Daniel Jo, source=Web Response No relevant relationships by David Turay, source=Web Response No relevant relationships by David Wong, source=Web Response