David R Vinson1, Nelya Lugovskaya2, E Margaret Warton3, Aaron M Rome4, Matthew D Stevenson5, Mary E Reed3, Manvi R Nagam3, Dustin W Ballard6. 1. Permanente Medical Group, Oakland, CA; Kaiser Permanente Division of Research, Oakland, CA; Department of Emergency Medicine, Kaiser Permanente Sacramento Medical Center, Sacramento, CA. Electronic address: drvinson@ucdavis.edu. 2. University of California-Davis School of Medicine, Sacramento, CA. 3. Kaiser Permanente Division of Research, Oakland, CA. 4. Permanente Medical Group, Oakland, CA; Department of Emergency Medicine, Kaiser Permanente South Sacramento Medical Center, Sacramento, CA. 5. Departments of Emergency Medicine, Stanford University, Palo Alto, CA, and Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA. 6. Permanente Medical Group, Oakland, CA; Kaiser Permanente Division of Research, Oakland, CA; Department of Emergency Medicine, Kaiser Permanente San Rafael Medical Center, San Rafael, CA.
Abstract
STUDY OBJECTIVE: Little is known about the use of ibutilide for cardioversion in atrial fibrillation and flutter outside of clinical trials. We seek to describe patient characteristics, ibutilide administration patterns, cardioversion rates, and adverse outcomes in the community emergency department (ED) setting. We also evaluate potential predictors of cardioversion success. METHODS: Using a retrospective cohort of adults who received ibutilide in 21 community EDs between January 2009 and June 2015, we gathered demographic and clinical variables from electronic health records and structured manual chart review. We calculated rates of cardioversion and frequency of ventricular tachycardia within 4 hours and estimated adjusted odds ratios (aOR) in a multivariate regression model for potential predictors of cardioversion. RESULTS: Among 361 patients, the median age was 61 years (interquartile range 53 to 71 years) and most had recent-onset atrial fibrillation and flutter (98.1%). Five percent of the cohort had a history of heart failure. The initial QTc interval was prolonged (>480 ms) in 29.4% of patients, and 3.1% were hypokalemic (<3.5 mEq/L). The mean ibutilide dose was 1.5 mg (SD 0.5 mg) and the rate of ibutilide-related cardioversion within 4 hours was 54.8% (95% confidence interval [CI] 49.6% to 60.1%), 50.5% for atrial fibrillation and 75.0% for atrial flutter. Two patients experienced ventricular tachycardia (0.6%), both during their second ibutilide infusion. Age (in decades) (aOR 1.3; 95% CI 1.1 to 1.5), atrial flutter (versus atrial fibrillation) (aOR 2.7; 95% CI 1.4 to 5.1), and no history of atrial fibrillation and flutter (aOR 2.0; 95% CI 1.2 to 3.1) were associated with cardioversion. CONCLUSION: The effectiveness and safety of ibutilide in this community ED setting were consistent with clinical trial results despite less stringent patient selection criteria.
STUDY OBJECTIVE: Little is known about the use of ibutilide for cardioversion in atrial fibrillation and flutter outside of clinical trials. We seek to describe patient characteristics, ibutilide administration patterns, cardioversion rates, and adverse outcomes in the community emergency department (ED) setting. We also evaluate potential predictors of cardioversion success. METHODS: Using a retrospective cohort of adults who received ibutilide in 21 community EDs between January 2009 and June 2015, we gathered demographic and clinical variables from electronic health records and structured manual chart review. We calculated rates of cardioversion and frequency of ventricular tachycardia within 4 hours and estimated adjusted odds ratios (aOR) in a multivariate regression model for potential predictors of cardioversion. RESULTS: Among 361 patients, the median age was 61 years (interquartile range 53 to 71 years) and most had recent-onset atrial fibrillation and flutter (98.1%). Five percent of the cohort had a history of heart failure. The initial QTc interval was prolonged (>480 ms) in 29.4% of patients, and 3.1% were hypokalemic (<3.5 mEq/L). The mean ibutilide dose was 1.5 mg (SD 0.5 mg) and the rate of ibutilide-related cardioversion within 4 hours was 54.8% (95% confidence interval [CI] 49.6% to 60.1%), 50.5% for atrial fibrillation and 75.0% for atrial flutter. Two patients experienced ventricular tachycardia (0.6%), both during their second ibutilide infusion. Age (in decades) (aOR 1.3; 95% CI 1.1 to 1.5), atrial flutter (versus atrial fibrillation) (aOR 2.7; 95% CI 1.4 to 5.1), and no history of atrial fibrillation and flutter (aOR 2.0; 95% CI 1.2 to 3.1) were associated with cardioversion. CONCLUSION: The effectiveness and safety of ibutilide in this community ED setting were consistent with clinical trial results despite less stringent patient selection criteria.
Authors: Ian G Stiell; Marco L A Sivilotti; Monica Taljaard; David Birnie; Alain Vadeboncoeur; Corinne M Hohl; Andrew D McRae; Judy Morris; Eric Mercier; Laurent Macle; Robert J Brison; Venkatesh Thiruganasambandamoorthy; Brian H Rowe; Bjug Borgundvaag; Catherine M Clement; Jennifer Brinkhurst; Erica Brown; Marie-Joe Nemnom; George A Wells; Jeffrey J Perry Journal: CJEM Date: 2021-01-18 Impact factor: 2.410
Authors: Filippo Cacioppo; Michael Schwameis; Nikola Schuetz; Julia Oppenauer; Sebastian Schnaubelt; Alexander Simon; Martin Lutnik; Sophie Gupta; Dominik Roth; Harald Herkner; Alexander Oskar Spiel; Anton Norbert Laggner; Hans Domanovits; Jan Niederdoeckl Journal: Int J Environ Res Public Health Date: 2022-05-28 Impact factor: 4.614
Authors: Laura E Simon; Mamata V Kene; E Margaret Warton; Adina S Rauchwerger; David R Vinson; Mary E Reed; Uli K Chettipally; Dustin G Mark; Dana R Sax; D Ian McLachlan; Dale M Cotton; James S Lin; Gabriela Vazquez-Benitez; Anupam B Kharbanda; Elyse O Kharbanda; Dustin W Ballard Journal: Acad Emerg Med Date: 2020-04-02 Impact factor: 3.451