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Ibutilide for the Control of Refractory Ventricular Tachycardia and Ventricular Fibrillation in Patients with Myocardial Ischemia and Hemodynamic Instability.


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Ibutilide for the Control of Refractory Ventricular Tachycardia and Ventricular Fibrillation in Patients with Myocardial Ischemia and Hemodynamic Instability.

J Cardiovasc Electrophysiol. 2018 Dec 22;:

Authors: Ferrer MS, Gonzalez MD

Abstract
INTRODUCTION: Recurrent ventricular tachycardia (VT) and ventricular fibrillation (VF) in patients with myocardial ischemia requiring hemodynamic support can be refractory to available antiarrhythmic agents and even to cardioversion and defibrillation. The purpose of this study was to report the effect of intravenous ibutilide in patients with a VT and/or VF storm in the presence of incomplete revascularization requiring hemodynamic support.
METHODS AND RESULTS: Standard continuous telemetry and frequent 12 lead electrocardiograms were obtained to determine the effect of intravenous Ibutilide in these patients. We studied 6 consecutive patients (age 60±12 years; 5 males) with incomplete revascularization and mechanical support (extracorporeal membrane of oxygenation=2; left ventricular assist device=4) with VT/VF refractory to lidocaine and amiodarone. Intravenous ibutilide was given as a last resort for management of their ventricular arrhythmias. Intravenous Ibutilide (1-2 mg) allowed restoration of sinus rhythm in 3 patients with persistent VF that were refractory to multiple defibrillation shocks. When the 24-hour period before and after Ibutilide administration were compared, this drug markedly reduced the number of required cardioversions/defibrillations in all patients from 20±9 to 0.7±0.8 shocks (p=0.036).
CONCLUSIONS: In patients with myocardial ischemia requiring hemodynamic support, intravenous Ibutilide demonstrates a potent antiarrhythmic effect and can facilitate defibrillation in patients with refractory VF. This article is protected by copyright. All rights reserved.

PMID: 30580467 [PubMed – as supplied by publisher]

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