Antiarrhythmic actions of intravenous ibutilide compared with procainamide during human atrial flutter and fibrillation : Electrophysiological determinants of Enhanced conversion efficacy

The selective class III antiarrhythmic agent ibutilide prolongs action potential duration and terminates atrial flutter (AFL) and fibrillation (AF), but the mechanism of its antiarrhythmic efficacy in humans has not been fully characterized. This study compared the antiarrhythmic effects of ibutilid...

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Bibliographic Details
Published in:Circulation (New York, N.Y.) N.Y.), 1997-12, Vol.96 (12), p.4298-4306
Main Authors: STAMBLER, B. S, WOOD, M. A, ELLENBOGEN, K. A
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Anti-Arrhythmia Agents - adverse effects
Anti-Arrhythmia Agents - therapeutic use
Antiarrhythmics
Antiarythmic agents
Atrial Fibrillation - drug therapy
Atrial Fibrillation - physiopathology
Atrial Flutter - drug therapy
Atrial Flutter - physiopathology
Biological and medical sciences
Cardiovascular system
Electrophysiology
Female
Humans
Injections, Intravenous
Male
Medical sciences
Middle Aged
Pharmacology. Drug treatments
Procainamide - adverse effects
Procainamide - therapeutic use
Sulfonamides - adverse effects
Sulfonamides - therapeutic use
Treatment Outcome
Citations: Items that this one cites
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Summary:The selective class III antiarrhythmic agent ibutilide prolongs action potential duration and terminates atrial flutter (AFL) and fibrillation (AF), but the mechanism of its antiarrhythmic efficacy in humans has not been fully characterized. This study compared the antiarrhythmic effects of ibutilide with the class IA agent procainamide in humans during AFL and AF. Antiarrhythmic drug actions and electrophysiological characteristics of AFL and AF that enhanced pharmacological termination were investigated. Right atrial monophasic action potentials were recorded during 148 episodes of AFL (n=89) or AF (n=59) in 136 patients treated with intravenous ibutilide (n=73) or placebo (n=22) as participants in randomized, double-blinded comparative studies or intravenous procainamide (n=53) in a concurrent open-label study. The conversion rates in AFL with ibutilide, procainamide, and placebo were 64% (29 of 45 patients), 0% (0 of 33), and 0% (0 of 11), respectively, whereas in AF the rates were 32% (9 of 28), 5% (1 of 20), and 0% (0 of 11), respectively. In AFL, ibutilide increased atrial monophasic action potential duration (MAPD) more (30% versus 18%, P
ISSN:0009-7322
1524-4539
DOI:10.1161/01.CIR.96.12.4298