New onset atrial fibrillation/flutter (AF) is a known complication of trauma and non-cardiac post-surgical patients. Ibutilide has been extensively studied in the post-cardiac surgical patient for rapid conversion of acute AF, but there has been no study to date that examines the use of this drug in the non-cardiac surgical population. The goal of the study is to look at the efficacy and safety of this class III agent in the trauma and non-cardiac post-surgical patients as it compares to the non-surgical population.
Patients recorded in our pharmacy database who received ibutilide were retrospectively reviewed. The data abstracted include demographics, ISS, APACHE II, independent risk factors for AF, types of injuries, onset, conversion success, and complications. All patients received beta-blocker and/or diltiazem for rate control prior to ibutilide administration. A uniform dose of ibutilide (1mg over 10 minutes) was given to all patients. Patients were all admitted to the ICU and monitored for QT prolongation, torsade de pointes, and severe hypotension as part of our hospital protocol.
A total of 24 patients received ibutilide since its addition to our formulary. 14 patients were surgical (12 trauma and 2 post-operative), and 10 patients were non-surgical patients. The risk stratification and ibutilide outcomes are listed in table 1
Severity of Illness and risk factors.Surgical (n=14) +/− SENon-surgical (n=10) +/− SEP valueAge63.6+/−3.968.7+/−4.50.30APACHE II6.0+/−1.15.4+/−1.20.70# risk factors1.0+/−.21.9+/−0.40.06Mortality14.2%30%0.36and 2
Ibutilide conversion rate.Surgical (n=13)Non-surgical (n=10)P value1st dose success68.2% (9)80% (8)0.412nd dose required15.4% (2)10% (1)0.40Failed conversion15.4% (2)10% (1)0.93, respectively. Mortality listed below is not drug related. No patients developed drug related complications. Average follow-up was 149.1 +/− 27.6 days with all patients remaining in sinus with comparable atrial fibrillation free days between groups, log rank p=0.47 (see figure).CONCLUSIONS: Ibutilide as a AF conversion agent is comparable in both the surgical and non-surgical population. These results are comparable to previously published data on cardiac surgical and medical patients.
Ibutilide is a safe and effective drug for the rapid conversion of acute AF in the trauma and non-cardiac surgical patients.
D. Turay, None.