RESUMEN
BACKGROUND: A study was conducted to determine the efficacy and safety of ibutilide fumarate versus placebo in the acute termination of atrial flutter and fibrillation. METHODS AND RESULTS: Two hundred sixty-two patients aged 28 to 88 years with atrial flutter or fibrillation duration of 3 hours to 90 days were randomly assigned in a 5:1 ratio (ibutilide:placebo) to receive two 10-minute infusions, 10 minutes apart, of ibutilide (1 mg) or placebo. Patients were hospitalized and monitored by telemetry for 24 hours, with follow-up 72 hours later. Seventy-three (34.9%) of 209 evaluable ibutilide recipients had termination of atrial flutter or fibrillation within 1.5 hours compared with 0 (0%) of 41 placebo recipients. Those with atrial flutter had a higher success rate. At hour 24, 86.3% remained in normal or alternative sinus rhythm. Of the patients who received ibutilide, 2.3% experienced drug-related sustained polymorphic or monomorphic ventricular tachycardia and recovered after intervention. Additionally, 7.3% experienced nonsustained polymorphic or monomorphic ventricular tachycardia. Other frequent medical events in ibutilide recipients were generally also noted in the placebo group. CONCLUSIONS: Ibutilide is effective and safe for acute termination of atrial fibrillation or atrial flutter.
Asunto(s)
Antiarrítmicos/administración & dosificación , Fibrilación Atrial/tratamiento farmacológico , Aleteo Atrial/tratamiento farmacológico , Sulfonamidas/administración & dosificación , Adulto , Anciano , Anciano de 80 o más Años , Método Doble Ciego , Esquema de Medicación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Missouri , Resultado del TratamientoRESUMEN
Since 1989, 78 patients have had Implantable Cardioverter Defibrillator (ICD) systems implanted in the Electrophysiology Laboratory (EPS) at the Charleston Area Medical Center. Between June 1993 and December 1994, 28 patients (21 males, 7 females) had new transvenous ICD systems successfully implanted in the Electrophysiology Laboratory. Coronary artery disease was present in 22 patients (76%). The mean left ventricular ejection fraction measured 28 percent (range 19%-45%), and the mean follow-up was 159 +/- 112 days (5.3 months). Twelve patients (43%) experienced shock, with an average of three per patient. The implantation of transvenous ICD systems in an electrophysiology laboratory is feasible, efficacious, safe, and associated with rapid patient recovery. With advances in technology, the procedure is becoming more comparable to a pacemaker implantation.
Asunto(s)
Enfermedad Coronaria/terapia , Desfibriladores Implantables , Cardiomiopatía Dilatada/terapia , Electrofisiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , West VirginiaRESUMEN
Cardioverter defibrillators were implanted in 26 patients at Charleston Area Medical Center for management of cardiac arrest (7 patients), and drug refractory sustained ventricular tachycardia (19 patients). A variety of operative approaches and concomitant surgical procedures were utilized in the implantation of these devices. No operative deaths occurred. A superficial wound infection was the only operative complication. During the follow-up period (9.3 +/- 5 months), 11 of 26 patients (46 percent) had a defibrillator discharge and one death occurred (3 percent), which was due to heart failure. Patients with malignant ventricular arrhythmias may present with sustained monomorphic ventricular tachycardia with associated syncope, pre-syncope or without any associated symptoms. Unfortunately, cardiac arrest may be the initial presentation. The use of antitachycardia devices such as implantable cardioverter defibrillators and antitachycardia pacemakers has allowed physicians to more successfully treat patients with malignant ventricular arrhythmias. In a significant number of patients with these arrhythmias, such devices are now used as first-line therapy.