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Objective:To analyze the general patterns and characteristics of torsade de pointes(Tdp) associated with ibutilide and provide feasible suggestions and preventive measurements combined with the experience of pharmaceutical monitoring. Methods: The cases of TdP associated with ibutilide were retrieved from the literatures reported at home and abroad during January 1990 and April 2017,and the clinical data including gender,age,original diseases, dosage of drugs, injection time, TdP occurrence time, potassi-um,QTc and ECG monitoring before and after the medication, complications, treatment drugs and methods and conversion outcome were statistically analyzed. Results: A total of 9 cases were enrolled in the analysis. After the treatment with ibutilide withdrawal, electroversion and potassium and magnesium supplement, all the patients converted to sinus rhythm.Conclusion: Ibutilide must be prescribed very carefully in senile female patients complicated with extended QTc,low potassium,organic heart disease and heart fail-ure. With dosing interval,injection time or injection speed not compatible with the specification,the occurrence of TdP is significantly different,suggesting that clinical pharmacists strengthen the monitoring of injection time,speed,dosing interval and blood concentra-tion of ibutilide according to the instruction strictly.
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Objective To investigate the effects of ibutilide and amiodarone on the ventricular transmural heteroge-neity of repolarization and ventricular arrhythmia for the treatment of atrial fibrillation. Methods Eighty-seven patients with paroxymal atrial fibrillation at 48 h~7 d were enrolled and randomized to two groups, ibutilide and amiodarone treat-ment groups. The successful rate of cardioversion to sinus rhythm was compared between two groups. The electrocardiograph-ic QT interval and Tpeak-end/QT ratio were also analyzed before and after treatment in two groups. Results The successful rate of cardioversion was significantly higher in ibutilide group than that of amiodarone group (61.7%vs 40.7%, P＜0.05). The QT intervals and Tpeak-end/QT ratio were both significantly increased in ibutilide group (P＜0.05), which were re-turned to the levels before treatment in 2 hours and 1 hour, respectively (P＜0.05). The QT intervals were significantly in-creased in the amiodarone group (P＜0.01), which were continued until 4 h after treatment. There were no significant differ-ences in the Tpeak-end/QT ratios before and after treatment (P>0.05). Conclusion The successful rate of cardioversion to sinus rhythm for atrial fibrillation by ibutilide was significantly higher compared with that of amiodarone. Ibutilide slightly in-creased the transmural heterogeneity of repolarization within the first hour, which may increase the risk of ventricular arrhyth-mia.
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ObjectiveTo evaluate the efficacy and safety of ibutilide for conversion of paroxysmal and persistent atrial fibrillation.Methods31 patients with atrial fibrillation duration less than 90 days were included into amiodrone or ibutilide group.16 patients were intravenously administer with amiodrone and 15 patients with ibutilide separately.Conversion rate,time needed to converse and adverse effects were compared between two groups.ResultsThe total conversion rate of ibutilide group was significantly higher than that of amiodrone group (66.7％ vs 37.5％,x2 =1.98,P ＜ 0.05 ).Time needed to converse was significantly shortened in ibutilide group compared with amiodrone group [ ( 31.75 ± 7.39 ) min vs ( 51.87 ± 9.26 ) min,t =3.67,P ＜ 0.05 ].No clinical significant adverse effects were observed in ibutilide group.ConclusionIntravenous administration of ibutilide in cardioversion of paroxysmal and persistent atrial fibrillation was more safe and effective than amiodrone.
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ObjectiveTo investigate the success rate and energy requirements of ibutilide and direct current(DC)cardioversion,summarize the nursing experience.MethodsForty-six patients with persistent atrial fibrillation were enrolled and underwent DC cardioversion were selelct from May 2009 to January 2011.23 patients received pretreatment with ibutilide before DC (the ibutilide group),23 patients received non drugs before DC (the control group).The cardioversion energy started at 100 J and increased if patients could not acquire sinus rhythm.All the patients were given pertinent care before,during and posttreatment.The success rate and energy requirements of the two groups were compared.Results95.7％ of the patients were successfully cardioverted in the ibutilide group,which was significantly higher than 74.0％ of the control group.The energy required for cardioversion was ( 139.1±45.1 ) J in the ibutilide group,significantly lower than (197.8±53.3) J in the control group.Non patients terminated treatment or appeared complication because of improper nursing.ConclusionsPretreatment with ibutilide enhanced the efficacy of DC cardioversion for the patients with persistent AF at lower energy requirements.Proper nursing care can ensure the smooth process of treatment and decrease the complications.
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Objective: To observe the electrophysiological effects of ibutilide on the normal cardiac conduction system and accessory pathways (AP) of patients with accessory pathways mediated reentrant tachycardia (AVRT) and to assess the safety of ibutilide in electrophysiology study (EPS) and radiofrequency catheter ablation (RFCA). Methods: Twenty-one patients with AVRT undergoing EPS received intravenous ibutilide (1 mg). Electrophysiological parameters, including P-A interval, A-H interval, H-V interval, QRS complex width, QT interval, paced QT interval, right atrial effective refractory period (RA ERP), right ventricular ERP (RV ERP)q atrioventricular node ERP (AVN ERP), AVN block cycle length (AVN BCD, antegrade AP ERP and retrograde AP ERP 9 were observed before and instantly, 15 min, and 30 min after injection of ibutilide. Results: There was no statistical difference in the P-A interval, A-H interval, H-V interval and QRS complex width before and after ibutilide injection(P>0.05). After injection of ibutilide, the QTc, QT intervals, the RA ERP, RV ERP, and AVN BCL were all significantly prolonged (P<0.05). The antegrade and retrograde ERP of AP were also increased (P<0.05), with no loss of antegrade and retrograde function of AP. All patients underwent successful ablation and Torsade de pointes (Tdp) and no other adverse effects were noticed. Conclusion: Ibutilide has no effect on the conductivity of normal cardiac conduction system. Routine dosage of ibutilide can prolong ERP of AP but does not block the conductivity, with no influence on electrophysiology study and radiofrequency catheter ablation. Ibutilide has no adverse effect on patients with AVRT.
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Objective To compare the safety and efficacy of ibutilide and amiodarone in converting post-coronary artery bypass grafting (CABG) new-onset atrial fibrillation (AF) to sinus rhythm. Methods This study was a prospective, singleblinded, randomized clinical trial. Totally 100 patients who met the inclusion criteria were enrolled and were intravenously treated with ibutilide (group A) or amiodarone (group B). In group A, Ibutilide was administered at a dose of 1 mg in 10 min, which was repeated after an interval of another 10 min if the arrhythmia was not converted; ibutilide was not given anymore no matter the conversion was achieved or not. In group B, amiodarone was administered at a dose of 5 mg/kg for the first 30 min, followed by 1 200 mg in the next 24 h; amiodarone was not given anymore no matter the conversion was achieved or not. Immediate conversion rate, conversion time and post-operative recurrence rate within 30 days were compared between the two groups. Results No severe adverse reactions were observed in both groups. The immediate conversion rate of group A was significantly higher than that of group B (82% vs 58% , P0.05). Conclusion Ibutilide and amiodarone are both safe in converting post-CABG new-onset AF to sinus rhythm, and ibutilide is more effective, more rapid in functioning and with a higher efficacy.