Ibutilide and the treatment of atrial arrhythmias

Ibutilide (Corvert@) is an intravenous class Ill antiarrhythmic agent used for the treatment of recent onset atrial fibrillation or atrial flutter. Pharmacological effect occurs within 30—60 min, and the efficacy approaches 30—44% in patients with atrial fibrillation and 60—78% in patients with atrial flutter. In contrast to electrical cardioversion, pharmacologic cardioversion offers an alternative in which anesthesia can be avoided. Ibutilide may be particularly useful in patients who have undergone recent cardiac or thoracic surgery or those who are not ideal candidates for electrical cardioversion and/or anesthesia. Patients receiving ibutilide should be monitored for at least 4 hours after drug administration because of the small risk of ventricular dysrhythmia, mainly torsades de pointes. The purpose of this article is to review the mechanisms, clinical applications, potential adverse effects, and appropriate use of ibutilide.