Ibutilide for Conversion of Atrial Fibrillation or Flutter in Community Emergency Departments

Ibutilide is a class III antiarrhythmic drug that is effective for cardioverting atrial fibrillation or flutter (AF/F). However, reported rates of induced ventricular tachycardia of around 1% may discourage its use (NEJM JW Cardiol and Heart 1998; 79:568). To examine safety and efficacy in real-world practice, investigators reviewed data from ibutilide administrations for AF/F at 21 community emergency departments (EDs) in the Kaiser Permanente Northern California system from 2009 to 2015.

Of 361 patients, 98% had recent-onset AF/F, 5% had history of heart failure, 29% had a prolonged (>480 ms) initial QTc interval, and 3% were hypokalemic (<3.5 mEq/L). The average ibutilide dose was 1.5 mg. Conversion to sinus rhythm within 4 hours occurred…