Termination of recent-onset atrial fibrillation/flutter in the emergency department: a sequential approach with intravenous ibutilide and external electrical cardioversion

Safety and effectiveness are the goals in treating patients with arrhythmia s. In an open prospective study, we observed the efficacy and safety of up to 2 mg intravenous ibutilide, a new class III antiarrhythmic agent in haem odynamically stable patients presenting in the emergency department (ED) wi th symptoms of recent-onset (< 48 h) atrial fibrillation/flutter. Arrhythmi a termination within 90 min, haemodynamic parameters and proarrhythmic effe cts were assessed. Non-responders to the ibutilide infusion underwent exter nal electrical cardioversion. We included 51 patients. In 31 patients thera peutic intervention with intravenous ibutilide was successful within 90 min (61%). In another seven patients conversion to sinus rhythm occurred after 90 min without any other intervention (14%). Blood pressure remained stabl e and no relevant proarrhythmic effects were observed. The 13 patients who did not respond to ibutilide treatment underwent successful external electr ical cardioversion. The overall conversion rate was 100%. Forty-seven patie nts (92%) were discharged within a median of 9 h and managed as outpatients . In conclusion, in haemodynamically stable patients with recent-onset atri al fibrillation/flutter intravenous ibutilide and external electrical cardi oversion for conversion to sinus rhythm turned out to be effective and safe . The short duration of admission makes this strategy attractive for use in the ED. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.