Skip to main content
SpringerLink
Log in

The Use of Drugs for Cardioversion of Recent Onset Atrial Fibrillation and Flutter

Focus on Ibutilide

  • Review Article
  • Drug Therapy
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Summary

Atrial fibrillation (AF) is the most common sustained arrhythmia, particularly in the elderly population. It is well recognised that AF is a major cause of stroke, even in the absence of underlying heart disease. Although AF and atrial flutter share many causes and may be seen in the same patient, there are differences between these arrhythmias: atrial flutter is less common, and the risk of stroke associated with it is less than that with AF. In addition to stroke, both AF and atrial flutter may cause cardiomyopathy, which may be fully reversible with effective treatment of the arrhythmia. Both AF and atrial flutter can result in severe symptoms and may precipitate heart failure, ischaemia and syncope. Recent research indicates that AF is a self-perpetuating arrhythmia, and that the longer it is left untreated the less likely it is that effective cardioversion will be possible.

Drugs are an attractive option for the cardioversion of AF and atrial flutter because their use does not require anaesthesia. Antiarrhythmic drugs in class III of the Vaughan-Williams classification are effective in the treatment of AF, but they have adverse effects; several new ‘pure’ class III agents are under development. The first of these to be made available is ibutilide, a methanesulphonamide erivative. Initial results are encouraging, particularly for atrial flutter. However, the drug has the potential for proarrhythmic effects and physicians who use it will need to be aware of these.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kannel WB, Abbott RD, Savage DD, et al. Epidemiologic features of atrial fibrillation: the Framingham study. N Engl J Med 1982; 306: 1018–22

    PubMed  CAS  Google Scholar 

  2. Kitchin AH, Milne JS. Longitudinal survey of ischaemic heart disease in a randomly selected sample of older population. Br Heart J 1977; 39: 889–93

    PubMed  CAS  Google Scholar 

  3. Gersh BJ. Epidemiology of atrial fibrillation and atrial flutter. In: DiMarco JP, Prystowsky EN, editors. Atrial arrhythmias: state of the art. Armonk (NY): Futura Publishing Company, Inc., 1996: 1–22

    Google Scholar 

  4. Bialy D, Lehmann MH, Schumacher DN, et al. Hospitalization for arrhythmias in the United States: importance of atrial fibrillation [abstract]. J Am Coll Cardiol 1992; 19: 41A

    Google Scholar 

  5. Bellet S. Clinical disorders of the heart beat. Philadelphia: Lea & Febiger, 1963: 144–5

    Google Scholar 

  6. Waldo AL, Maclean WAH. Diagnosis and treatment of arrhythmias following open heart surgery — emphasis on the use of epicardial wire electrodes. New York: Futura Publishing, 1980

    Google Scholar 

  7. Van Gelder IC, Crijns HJ, Van Gilst WH, et al. Prediction of uneventful cardioversion and maintenance of sinus rhythm from direct-current electrical cardioversion of chronic atrial fibrillation and flutter. Am J Cardiol 1991; 68: 41–6

    PubMed  Google Scholar 

  8. Murgatroyd FD, Curzen NP, Aldergather J, et al. Clinical features and drug therapy in patients with paroxysmal atrial fibrillation: results of the CRAFT multi-center database [abstract]. J Am Coll Cardiol 1993; 21: 380A

    Google Scholar 

  9. Goldberg RJ, Seeley D, Becker RC, et al. Impact of atrial fibrillation on the in-hospital and long-term survival of patients with acute myocardial infarction: a community-wide perspective. Am Heart J 1990; 119: 996–1001

    PubMed  CAS  Google Scholar 

  10. Serrano CVJ, Ramires JA, Mansur AP, et al. Importance of the time of onset of supraventricular tachyarrhythmias on prognosis of patients with acute myocardial infarction. Clin Cardiol 1995; 18: 84–90

    PubMed  Google Scholar 

  11. Behar S, Zahavi Z, Goldbourt U, et al., SPRINT study group. Long-term prognosis of patients with paroxysmal atrial fibrillation complicating acute myocardial infarction. Eur Heart J 1992; 13: 45–50

    PubMed  CAS  Google Scholar 

  12. Krahn AD, Manfreda J, Tate RB, et al. The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba follow-up study. Am J Med 1995; 98: 476–84

    PubMed  CAS  Google Scholar 

  13. Robinson K, Frenneaux MP, Stockins B, et al. Atrial fibrillation in hypertrophie cardiomyopathy: a longitudinal study. J Am Coll Cardiol 1990; 15: 1279–85

    PubMed  CAS  Google Scholar 

  14. Mathew JP, Parks R, Savino JS, et al. Atrial fibrillation following coronary artery bypass graft surgery. JAMA 1996; 267: 300–6

    Google Scholar 

  15. Aranki SF, Shaw DP, Adams DH, et al. Predictors of atrial fibrillation after coronary artery surgery: current trends and impact on hospital resources. Circulation 1996; 94: 390–7

    PubMed  CAS  Google Scholar 

  16. Lauer MS, Eagle KA. Atrial fibrillation following cardiac surgery. In: Falk RH, Podrid PJ, editors. Atrial fibrillation: mechanisms and management. New York: Raven, 1992: 127–43

    Google Scholar 

  17. Rubin DA, Nieminski KE, Reed GE, et al. Predictors, prevention, and long-term prognosis of atrial fibrillation after coronary artery bypass graft operations. J Thorac Cardiovasc Surg 1987; 94: 331–5

    PubMed  CAS  Google Scholar 

  18. Casthely PA, Yoganathan T, Komer C, et al. Magnesium and arrhythmias after coronary artery bypass surgery. J Cardiothorac Vasc Anesth 1994; 8: 188–91

    PubMed  CAS  Google Scholar 

  19. Mendes LA, Connelly GP, Davidoff R. Right artery coronary stenosis: an independent predictor of atrial fibrillation after coronary artery bypass surgery. J Am Coll Cardiol 1995; 25: 198–202

    PubMed  CAS  Google Scholar 

  20. Ali AS, Fenn NM, Zarowitz BJ, et al. Epidemiology of atrial fibrillation in patients hospitalised in a large hospital. Panminerva Med 1993; 35: 209–13

    PubMed  CAS  Google Scholar 

  21. Murgatroyd FD, Camm AJ. Atrial arrhythmias. Lancet 1993; 341: 1317–22

    PubMed  CAS  Google Scholar 

  22. Vaidya PN, Bhoseley PN, Rao DB. Tachyarrhythmias in old age. J Am Geriatr Soc 1976; 24: 412–4

    PubMed  CAS  Google Scholar 

  23. Onundarson PT, Thorgeirsson D, Jonmudsson E. Chronic atrial fibrillation: epidemiologic features and 14 year follow-up: a case control study. Eur Heart J 1987; 8: 521–7

    PubMed  CAS  Google Scholar 

  24. Cairns JA, Connelly SJ. Nonrheumatic atrial fibrillation: risk of stroke and antithrombotic therapy. Circulation 1991; 84: 469–81

    PubMed  CAS  Google Scholar 

  25. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham study. Stroke 1991; 22: 983–8

    PubMed  CAS  Google Scholar 

  26. Wolf PA, Abbot RD, Kannel WB. Atrial fibrillation: a major contributor to stroke in the elderly. Arch Intern Med 1987; 147: 1561–4

    PubMed  CAS  Google Scholar 

  27. Lin HJ, Wolf PA, Benjamin EJ, et al. Newly diagnosed atrial fibrillation and acute stroke: the Framingham study. Stroke 1995; 26: 1527–30

    PubMed  CAS  Google Scholar 

  28. Wolf PA, Dawber TR, Thomas HE, et al. Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham study. Neurology 1978; 28: 973–7

    PubMed  CAS  Google Scholar 

  29. The Stroke Prevention in Atrial Fibrillation Investigators. Predictors of thromboembolism in atrial fibrillation: I. Clinical features of patients at risk. Ann Intern Med 1992; 116: 1–5

    Google Scholar 

  30. Petersen P, Madsen EB, Brun B, et al. Silent cerebral infarction in chronic atrial fibrillation. Stroke 1987; 18: 1098–100

    PubMed  CAS  Google Scholar 

  31. Ott A, Breteler MM, de Bruyne MC, et al. Atrial fibrillation and dementia in a population-based study: the Rotterdam study. Stroke 1997; 28: 316–21

    PubMed  CAS  Google Scholar 

  32. Tunick PA, McElhinney L, Mitchell T, et al. The alternation between atrial flutter and atrial fibrillation. Chest 1992; 101: 34–6

    PubMed  CAS  Google Scholar 

  33. Wood KA, Eisenberg SJ, Kalman JM, et al. Risk of thromboembolism in chronic atrial flutter. Am J Cardiol 1997; 79: 1043–7

    PubMed  CAS  Google Scholar 

  34. Karnegis JN, Matoole JJ, Bjorling VG. Immediate improvement in left ventricular function after cardioversion of atrial flutter. Am J Cardiol 1989; 64: 1043–7

    PubMed  CAS  Google Scholar 

  35. Kieney JR, Sacrez A, Facello A, et al. Increase in radionuclide left ventricular ejection fraction after cardioversion of chronic atrial fibrillation in idiopathic dilated cardiomyopathy. Eur Heart J 1992; 13: 1290–5

    Google Scholar 

  36. Grogan M, Smith HC, Gersh BJ, et al. Left ventricular dysfunction due to atrial fibrillation in patients initially believed to have idiopathic dilated cardiomyopathy. Am J Cardiol 1992; 69: 1570–3

    PubMed  CAS  Google Scholar 

  37. Peters KG, Kienzle MG. Severe cardiomyopathy due to chronic rapidly conducted atrial fibrillation: complete recovery after restoration of sinus rhythm. Am J Med 1988; 85: 242–4

    PubMed  CAS  Google Scholar 

  38. Van Den Berg MP, van Veldhuisen DJ, Crijns HJ, et al. Reversion of tachycardiomyopathy after beta-blocker [letter]. Lancet 1993; 341: 1667

    PubMed  Google Scholar 

  39. Packer DL, Bardy GH, Worley SJ, et al. Tachycardia-induced cardiomyopathy: a reversible form of left ventricular dysfunction. Am J Cardiol 1986; 57: 563–70

    PubMed  CAS  Google Scholar 

  40. Roberts SA, Diaz C, Nolan PE, et al. Effectiveness and costs of digoxin treatment for atrial fibrillation and flutter. Am J Cardiol 1993; 72: 567–73

    PubMed  CAS  Google Scholar 

  41. Alberts MJ, Bennett CA, Rutledge VR. Hospital charges for stroke patients. Stroke 1996; 27: 1825–8

    PubMed  CAS  Google Scholar 

  42. Taylor TN, Davis PH, Tomer JC, et al. Lifetime cost of stroke in the United States. Stroke 1996; 27: 1459–66

    PubMed  CAS  Google Scholar 

  43. Scott WG, Scott WE. Ischaemic stroke in New Zealand: an economic study. N Z Med J 1994; 107: 443–6

    PubMed  CAS  Google Scholar 

  44. Inoue H, Matsuo H, Takayanagi K, et al. Clinical and experimental studies of the effects of atrial extrastimulation and rapid pacing on atrial flutter cycle: evidence of macro-reentry with an excitable gap. Am J Cardiol 1981; 48: 623–31

    PubMed  CAS  Google Scholar 

  45. Olgin JE, Kalman JM, Fitzpatrick AP, et al. Role of right atrial endocardial structures as barriers to conduction during human type I atrial flutter. Circulation 1995; 92: 1839–48

    PubMed  CAS  Google Scholar 

  46. Lesh MD, Van Hare GF, Epstein LM, et al. Radiofrequency catheter ablation of atrial arrhythmias — results and mechanisms. Circulation 1994; 89: 1074–89

    PubMed  CAS  Google Scholar 

  47. Kalman JM, Olgin JE, Saxon LA, et al. Electrocardiographic and electrophysiologic characterisation of atypical atrial flutter in man: use of activation and entrainment mapping and implications for catheter ablation. J Cardiovasc Electrophysiol 1997; 8: 121–44

    PubMed  CAS  Google Scholar 

  48. Wells JLJ, Maclean WAH, James TN, et al. Characterization of atrial flutter: studies in man after open heart surgery using fixed atrial electrodes. Circulation 1979; 60: 665–73

    PubMed  Google Scholar 

  49. Moe GK. On the multiple wavelet hypothesis of atrial fibrillation. Arch Int Pharmacodyn Ther 1962; 140: 183–8

    Google Scholar 

  50. Konings K, Kirchhof CJHJ, Smeets JRLM, et al. High-density mapping of electrically induced atrial fibrillation in humans. Circulation 1994; 89: 1665–80

    PubMed  CAS  Google Scholar 

  51. Wiener N, Rosenbleuth A. The mathematical formulation of the problem of conduction of impulses in a network of connected excitable elements, specifically in cardiac muscle. Arch Inst Cardiol Mex 1946; 16: 205–65

    PubMed  CAS  Google Scholar 

  52. Wijffels MCEF, Kirchhof CJHJ, Dorland R, et al. Atrial fibrillation begets atrial fibrillation: a study in awake chronically instrumented goats. Circulation 1995; 92: 1954–68

    PubMed  CAS  Google Scholar 

  53. Daoud EG, Bogun F, Goyal R, et al. Effect of atrial fibrillation on atrial refractoriness in humans. Circulation 1996; 94(7): 1600–6

    PubMed  CAS  Google Scholar 

  54. Shimizu A, Fukatani M, Tanigawa M, et al. Intra-atrial conduction delay and fragmented atrial activity in patients with paroxysmal atrial fibrillation. Jpn Circ J 1989; 53: 1023–30

    PubMed  CAS  Google Scholar 

  55. Hashiba K, Tanigawa M, Fukatani M, et al. Electrophysiologic properties of atrial muscle in paroxysmal atrial fibrillation. Am J Cardiol 1989; 64(20): 20J–23J

    PubMed  CAS  Google Scholar 

  56. Allessie MA, Rensma PL, Brugada J, et al. Pathophysiology of atrial fibrillation. In: Zipes DP, Jalife J, editors. Cardiac electrophysiology: from cell to bedside. Philadelphia: W.B. Saunders, 1990: 548–59

    Google Scholar 

  57. Henry WL, Morganroth J, Pearlman AS, et al. Relation between echocardiographically determined left atrial size and atrial fibrillation. Circulation 1976; 53: 273–9

    PubMed  CAS  Google Scholar 

  58. The Cardiac Arrhythmia Suppression Trial (CAST) Investigators. Preliminary report: effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. N Engl J Med 1989; 321: 406–12

    Google Scholar 

  59. Winkle RA, Mason JW, Griffin JC, et al. Malignant ventricular tachyarrhythmias associated with the use of encainide. Am Heart J 1981; 102: 857–64

    PubMed  CAS  Google Scholar 

  60. Anastasiou Nana MI, Anderson JL, Stewart JR, et al. Occurrence of exercise-induced and spontaneous wide complex tachycardia during therapy with flecainide for complex ventricular arrhythmias: a probable proarrhythmic effect. Am Heart J 1987; 113: 1071–7

    PubMed  CAS  Google Scholar 

  61. Falk RH. Flecainide-induced ventricular tachycardia and fibrillation in patients treated for atrial fibrillation. Ann Intern Med 1989; 111: 107–11

    PubMed  CAS  Google Scholar 

  62. Coplen SE, Antman EM, Berlin JA, et al. Efficacy and safety of quinidine therapy for maintenance of sinus rhythm after cardioversion: a meta-analysis of randomized control trials. Circulation 1990; 82: 1106–16

    PubMed  CAS  Google Scholar 

  63. Feld GK, Chen P, Nicod PH, et al. Possible atrial proarrhythmic effects of class 1c antiarrhythmic drugs. Am J Cardiol 1990; 66: 378–83

    PubMed  CAS  Google Scholar 

  64. Lee KS. Ibutilide, a new compound with potent class III antiarrhythmic activity, activates a slow inward Na+ current in guinea pig ventricular cells. J Pharmacol Exp Ther 1992; 262: 99–108

    PubMed  CAS  Google Scholar 

  65. Yang T, Snyders DJ, Roden DM. Ibutilide, a methanesulfonamide anti-arrhythmic, is a potent blocker of the rapidly activating delayed rectifier K+ current (Ikr) in AT-1 cells: concentration-, time-, voltage-, and use-dependent effects. Circulation 1995; 91: 1799–806

    PubMed  CAS  Google Scholar 

  66. Buchanan LV, Thompson DD, Hsu CL, et al. Antiarrhythmic and electrophysiologic effects of sublingual ibutilide fumarate. Drug Dev Res 1995; 34: 322–8

    CAS  Google Scholar 

  67. Naccarelli GV, Lee KS, Gibson JK, et al. Electrophysiology and pharmacology of ibutilide. Am J Cardiol 1996; 78: 6–12

    Google Scholar 

  68. Ellenbogen KA, Wood MA, Stambler BS, et al. Conversion of atrial fibrillation and flutter by intravenous ibutilide: a multicentre dose response study [abstract]. J Am Coll Cardiol 1994 Feb; Spec. iss.: 227A

    Google Scholar 

  69. DiMarco JP. Cardioversion of atrial flutter by intravenous ibutilide: a new class III antiarrhythmic agent [abstract]. J Am Coll Cardiol 1991; 17: 324A

    Google Scholar 

  70. Ellenbogen KA, Stambler BS, Wood MA, 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: 130–6

    PubMed  CAS  Google Scholar 

  71. Stambler BS, Wood MA, Ellenbogen KA, et al. Efficacy and safety of repeated doses of ibutilide for rapid conversion of atrial flutter or fibrillation. Circulation 1996; 94: 1613–21

    PubMed  CAS  Google Scholar 

  72. Faniel R, Schoenfeld P. Efficacy of i.V. amiodarone in converting rapid atrial fibrillation and flutter to sinus rhythm in intensive care patients. Eur Heart J 1983; 4: 180–5

    PubMed  CAS  Google Scholar 

  73. Anastasiou Nana MI, Levis GM, Moulopoulos SD. Amiodarone — application and clinical pharmacology in atrial fibrillation and other arrhythmias. Int J Clin Pharmacol Ther Toxicol 1984; 22: 229–35

    PubMed  CAS  Google Scholar 

  74. Strasberg B. Intravenous amiodarone for conversion of atrial fibrillation to sinus rhythm. Am J Cardiol 1991; 67: 325

    PubMed  CAS  Google Scholar 

  75. Borgeat A, Goy JJ, Maendly R, et al. Flecainide versus quinidine for conversion of atrial fibrillation to sinus rhythm. Am J Cardiol 1986; 58: 496–8

    PubMed  CAS  Google Scholar 

  76. Hellestrand KJ. Intravenous flecainide acetate for supraventricular tachycardias. Am J Cardiol 1988; 62(6): 16D–22D

    PubMed  CAS  Google Scholar 

  77. Goy JJ, Kaufmann U, Kappenberger LJ, et al. Restoration of sinus rhythm with flecainide in patients with atrial fibrillation. Am J Cardiol 1988; 62(6): 38D–40D

    PubMed  CAS  Google Scholar 

  78. Crijns HJ, Van Wijk LM, Van Gilst WH, et al. Acute conversion of atrial fibrillation to sinus rhythm: clinical efficacy of flecainide acetate. Comparison of two regimens. Eur Heart J 1988; 9: 634–8

    PubMed  CAS  Google Scholar 

  79. Bianconi L, Boccadamo R, Pappalardo A, et al. Effectiveness of intravenous propafenone for conversion of atrial fibrillation and flutter of recent onset. Am J Cardiol 1989; 64: 335–8

    PubMed  CAS  Google Scholar 

  80. Platia EV, Michelson EL, Porterfield JK, et al. Esmolol versus verapamil in the acute treatment of atrial fibrillation or atrial flutter. Am J Cardiol 1989; 63: 925–9

    PubMed  CAS  Google Scholar 

  81. Suttorp MJ, Kingma JH, Jessurun ER, et al. The value of class IC antiarrhythmic drugs for acute conversion of paroxysmal atrial fibrillation or flutter to sinus rhythm. J Am Coll Cardiol 1990; 16: 1722–7

    PubMed  CAS  Google Scholar 

  82. Mostow ND, Vrobel TR, Noon D, et al. Rapid control of refractory atrial tachyarrhythmias with high-dose oral amiodarone. Am Heart J 1990; 120: 1356–63

    PubMed  CAS  Google Scholar 

  83. Stambler BS, Wood MA, Ellenbogen KA. Antiarrhythmic actions of intravenous ibutilide compared with procainamide during human atrial flutter and fibrillation — electrophysiological determinants of enhanced conversion efficacy. Circulation 1997; 96: 4298–306

    PubMed  CAS  Google Scholar 

  84. Crijns HJGM, Van Gelder IC, Kingma JH, et al. Atrial flutter can be terminated by a class III antiarrhythmic drug but not by a class I drug. Eur Heart J 1994; 15: 1403–8

    PubMed  CAS  Google Scholar 

  85. Guo GB, Ellenbogen KA, Wood MA, et al. Conversion of atrial flutter by ibutilide is associated with increased atrial cycle length variability. J Am Coll Cardiol 1996; 27: 1083–9

    PubMed  CAS  Google Scholar 

  86. Roden DM. Ibutilide and the treatment of atrial arrhythmias. Circulation 1996; 94: 1499–502

    PubMed  CAS  Google Scholar 

  87. Curran ME, Splawski I, Timothy KW, et al. A molecular basis for cardiac arrhythmia: HERG mutations cause long QT syndrome. Cell 1995; 80: 795–803

    PubMed  CAS  Google Scholar 

  88. Wang Q, Curran ME, Keating MT, et al. Positional cloning of a novel potassium gene: KVLQTI mutations cause cardiac arrhythmias. Nature Genet 1996; 12: 17–23

    PubMed  Google Scholar 

  89. Haverkamp W, Shenesa M, Borgeffe M, et al. Torsades de pointes. In: Zipes DP, Jalife J, editors. Cardiac electrophysiology: from cell to bedside. Philadelphia: WB. Saunders Co., 1995: 885–99

    Google Scholar 

  90. Waldo AL, Camm AJ, deRuyter H, et al., SWORD Investigators. Effect of d-sotalol on mortality in patients with left ventricular dysfunction after recent and remote myocardial infarction: survival with oral d-sotalol. Lancet 1996; 348: 7–12

    PubMed  CAS  Google Scholar 

  91. Manning WJ, Silverman DI, Katz SE, et al. Impaired left atrial mechanical function after cardioversion: relation to the duration of atrial fibrillation. J Am Coll Cardiol 1994; 23: 1535–40

    PubMed  CAS  Google Scholar 

  92. Abascal VM, Dubrey S, Ochoa MR, et al. Electrical vs pharmacologic cardioversion in atrial fibrillation: does the atrium really care? [abstract] Circulation 1995; 92Suppl. I: 591

    Google Scholar 

  93. Manning WJ, Silverman DI, Katz SE, et al. Temporal dependence of the return of atrial mechanical function on the mode of cardioversion of atrial fibrillation to sinus rhythm. Am J Cardiol 1995; 75: 624–6

    PubMed  CAS  Google Scholar 

  94. Laupacis A, Albers G, Dunn M, et al. Antithrombotic therapy in atrial fibrillation. Chest 1992; 102Suppl. 4: 426S–33S

    PubMed  CAS  Google Scholar 

  95. Fatkin D, Carroll G, Kuchar D, et al. Thromboembolic complications after pharmacologic cardioversion of atrial fibrillation. Aust N Z J Med 1994; 24: 584

    PubMed  CAS  Google Scholar 

  96. Senarath Yapa RS, Green GJ. Embolie stroke following cardioversion of atrial fibrillation to sinus rhythm with oral amiodarone therapy. Postgrad Med J 1990; 66: 410

    Google Scholar 

  97. Olshansky B. Management of atrial fibrillation after coronary artery bypass graft. Am J Cardiol 1996; 78: 27–34

    PubMed  CAS  Google Scholar 

  98. Mattioni T, Denker S, Riggio D, et al. Efficacy and safety of intravenous ibutilide in the treatment of atrial flutter and atrial fibrillation following valvular or coronary artery bypass surgery [abstract]. Pacing Clin Electrophysiol 1997; 20 (4 Pt II): 1059

    Google Scholar 

  99. Stambler BS, Wood MA, Ellenbogen KA. Comparative efficacy of intravenous ibutilide versus procainamide for enhancing termination of atrial flutter by atrial overdrive pacing. Am J Cardiol 1996; 77: 960–6

    PubMed  CAS  Google Scholar 

  100. Buchanan LV, Turcotte UM, Kabell GG, et al. Antiarrhythmic and electrophysiologic effects of ibutilide in a chronic canine model of atrial flutter. J Cardiovasc Pharmacol 1993; 33: 10–4

    Google Scholar 

  101. Resnekov L, McDonald L. Electroversion of lone atrial fibrillation and flutter including haemodynamic studies at rest and on exercise. Br Heart J 1971; 33: 339–50

    PubMed  CAS  Google Scholar 

  102. Phillips BG, Bauman JL. Prescribing trends and pharmacoeconomic considerations in the treatment of arrhythmias: focus on atrial fibrillation and flutter. Pharmacoeconomics 1995; 7: 521–33

    PubMed  CAS  Google Scholar 

  103. Brodsky MA, Allen BJ, Walker CJ, et al. Amiodarone for maintenance of sinus rhythm after conversion of atrial fibrillation in the setting of a dilated left atrium. Am J Cardiol 1987; 60: 572–5

    PubMed  CAS  Google Scholar 

  104. Middlekauff HR, Wiener I, Stevenson WG. Low-dose amiodarone for atrial fibrillation. Am J Cardiol 1993; 72(16): 75F–81F

    PubMed  CAS  Google Scholar 

  105. Gosselink AT, Crijns HJ, Van Gelder IC, et al. Low-dose amiodarone for maintenance of sinus rhythm after cardioversion of atrial fibrillation or flutter. JAMA 1992; 267: 3289–93

    PubMed  CAS  Google Scholar 

  106. Juul-Moller S, Edvardsson N, Rehnqvist-Ahlberg N. Sotalol versus quinidine for the maintenance of sinus rhythm after direct current conversion of atrial fibrillation. Circulation 1990; 82: 1932–9

    PubMed  CAS  Google Scholar 

  107. Antman EM, Beamer AD, Cantillon C, et al. Therapy of refractory symptomatic atrial fibrillation and atrial flutter: a staged care approach with new antiarrhythmic drugs. J Am Coll Cardiol 1990; 15: 698–707

    PubMed  CAS  Google Scholar 

  108. Crijns HJ, Van Gelder IC, Van Gilst WH, et al. Serial antiarrhythmic drug treatment to maintain sinus rhythm after electrical cardioversion for chronic atrial fibrillation or atrial flutter. Am J Cardiol 1991; 68: 335–41

    PubMed  CAS  Google Scholar 

  109. Disch DL, Greenberg ML, Holzberger PT, et al. Managing chronic atrial fibrillation: a Markov decision analysis comparing warfarin, quinidine, and low-dose amiodarone. Ann Intern Med 1994; 120: 449–57

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiological Sciences, St George’s Hospital Medical School, Cranmer Terrace, London, SW17 0RE, England

    Owen A. Obel & A. John Camm

Authors
  1. Owen A. Obel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. John Camm
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Owen A. Obel.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Obel, O.A., Camm, A.J. The Use of Drugs for Cardioversion of Recent Onset Atrial Fibrillation and Flutter. Drugs & Aging 12, 461–476 (1998). https://doi.org/10.2165/00002512-199812060-00004

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00002512-199812060-00004

Keywords

Search

Navigation