Intravenous ibutilide versus intravenous amiodarone for post-operative management of atrial fibrillation following coronary artery bypass grafting: a prospective randomized controlled double blinded trial
Keywords:Post-operative atrial fibrillation, Amiodarone, Ibutilide, Coronary artery bypass grafting
Background: Increased incidence of post-operative atrial fibrillation (POAF) is responsible for more post-operative complications, length of hospital stay and subsequent higher costs of hospitalization. This study was done to compare the efficacy and safety of ibutilide versus amiodarone for treatment of POAF following coronary artery bypass grafting (CABG).
Methods: In this prospective, randomized, double blind controlled study, 60 patients posted for CABG developing POAF, divided randomly into 30 patients each in groups A and group I. Group A received IV amiodarone at 3 mg/kg over 20 minutes and group I received IV ibutilide at 0.01 mg/kg over 10 minutes (weight <60 kg) or 1 mg over 10 minutes (weight >60 kg). Patients underwent standard anesthetic technique and monitoring for CABG. All the demographic data, hemodynamic data were recorded in a structured manner.
Results: Ibutilide showed significantly faster resolution of AF at 12.47±5.3 versus 22.9±7.68 minutes by amiodarone (p=0.000). Ibutilide was found to have significantly higher incidences of recurrence at 23.3% versus 0% by amiodarone (p=0.0048). Ibutilide showed significantly lesser hypotension 0% versus 26.67% with amiodarone (p=0.002).
Conclusions: This study concluded that ibutilide was found to be better suited to treat POAF patients, who underwent CABG; due to its early and efficient resolution and reduced risk of hypotension.
Kalavrouziotis D, Buth KJ, Ali IS. The impact of new-onset atrial fibrillation on in-hospital mortality following cardiac surgery. Chest. 2007;131(3):833-9.
Lloyd-Jones DM, Wang TJ, Leip EP, Larson MG, Levy D, Vasanet RS, et al. Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation. 2004;110(9):1042-6.
Aranki SF, Shaw DP, Adams DH, Rizzo RJ, Couper GS, VanderVliet M, et al. Predictors of atrial fibrillation after coronary artery surgery. Current trends and impact on hospital resources. Circulation. 1996;94(3):390-7.
Mathew JP, Fontes ML, Tudor IC, Ramsay J, Duke P, Mazeret CD, et al. A multicenter risk index for atrial fibrillation after cardiac surgery. JAMA. 2004;291(14):1720-9.
Kaw R, Hernandez AV, Masood I, Gillinov AM, Saliba W, Blackstone EH. Short- and long-term mortality associated with new-onset atrial ﬁbrillation after coronary artery bypass grafting: a systematic review and meta-analysis. J Thorac Cardiovasc Surg. 2011;141(5):1305-12.
Maisel WH, Rawn JD, Stevenson WG. Atrial fibrillation after cardiac surgery. Ann Intern Med. 2001;135(12):1061-73.
Vardas PE, Kochiadakis GE, Igoumenidis NE, Tsatsakis AM, Simantirakis EN. Amiodarone as a first-choice drug for restoring sinus rhythm in patients with atrial fibrillation. CHEST. Am Coll Chest Phys. 2015;117(6):1538-45.
Blanc JJ, Voinov C, Maarek M. Comparison of oral loading dose of propafenone and amiodarone for converting recent-onset atrial fibrillation. PARSIFAL Study Group. Am J Cardiol. 1999;84(9):1029-32.
Bernard EO, Schmid ER, Schmidlin D, Scharf C, Candinas R, Germann R. Ibutilide versus amiodarone in atrial fibrillation: a double blinded, randomized study. Crit Care Med. 2003;31(4):1031-4.
Soucier R, Silverman D, Abordo M, Jaagosild P, Abiose A, Madhusoodanan KP, et al. Propafenone versus ibutilide for post operative atrial ﬁbrillation following cardiac surgery: neither strategy improves outcomes compared to rate control alone (the PIPAF study). Med Sci Monit. 2003;9(3):19-23.
Camm AJ, Lip GY, DeCaterina R, Savelieva I, Atar D, Hohnloser SH, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Europace. 2012;14(21):138-413.
Kafkas NV, Patsilinakos SP, Mertzanos GA, Papageorgiou KI, Chaveles JI, Dagadaki OK, et al. Conversion efficacy of intravenous ibutilide compared with intravenous amiodarone in patients with recent-onset atrial fibrillation and atrial flutter. Int J Cardiol. 2007;118(3):321-5.
Schwartz RA, Langberg JJ. Atrial electrophysiological effects of ibutilide infusion in humans. PACE. 2000:23(5):832-6.
Mitchell LB, Exner DV, Wyse DG, Connolly CJ, Prystai GD, Bayes AJ, et al. Prophylactic oral amiodarone for the prevention of arrhythmias that begin early after revascularization, valve replacement, or repair: PAPABEAR: a randomized controlled trial. JAMA. 2005:294(24):3093-100.
Patel AA, White CM, Gillespie EL, Kluger J, Coleman CI. Safety of amiodarone in the prevention of postoperative atrial fibrillation: a meta-analysis. Am J Health-Syst Pharm. 2006:63(9):829-37.
Ellenbogen KA, Stambler BS, Wood MA, Sager PT, Wesley RC, Meissner MC, et al. Efficacy of intravenous ibutilide for rapid termination of atrial fibrillation and atrial flutter: a dose-response study. J Am Coll Cardiol. 1996;28(1):130-6.
Hongo RH, Themistoclakis S, Raviele A. Use of ibutilide in cardioversion of patients with atrial fibrillation or atrial flutter treated with class IC agents. J Am Coll Cardiol. 2004;44(4):864-8.
VanderLugt JT, Mattioni T, Denker S, Torchiana D, Ahern T, Wakefield LK, et al. Efficacy and safety of ibutilide fumarate for the conversion of atrial arrhythmias after cardiac surgery. Circulation. 1999;100(4):369-75.