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Europace 2004 6(4):301-306; doi:10.1016/j.eupc.2004.03.007
© 2004 by European Society of Cardiology
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Efficacy and safety of ibutilide vs. transoesophageal atrial pacing for the termination of type I atrial flutter

Andrea Mazzaa,*, Maria Stella Feraa, Irma Biscegliaa, Francesca Bettiolb, Giovanni Pulignanoa, Pietro Tanzib, Carlo Gaudioc and Ezio Giovanninia

aI Division of Cardiology, S. Camillo Hospital Rome, Italy; bCentral Service of Cardiology, S. Camillo Hospital Rome, Italy; cCardiology Department, University "La Sapienza" Rome, Italy

AIMS: Comparing efficacy and safety of ibutilide vs. transoesophageal atrial pacing (ATP) for the termination of type I atrial flutter (AFL).

METHODS AND RESULTS: Eighty-seven patients affected by AFL lasting between 2 h and 30 days were randomized in two groups: Group 1—i.v. ibutilide treatment, up to 2 mg, and Group 2—ATP, with "burst" and "ramp" pacing protocols. Sinus rhythm was restored in 36/45 (80%) patients in Group 1 vs. 18/42 (43%) in Group 2 (P<0.0005). In Group 1, mean AFL duration was 11.4 ± 7.7 days in responders vs. 12.1 ± 7.6 in non-responders (P=ns), while in Group 2 it was 2.7 ± 1.4 vs. 14.2 ± 5.4 days (responders vs. non-responders, respectively, P<0.0001); 30/36 (83%) responders in Group 1 had AFL >48 h vs. 10/18 (56%) responders in Group 2 (P<0.05). Non-sustained polymorphic ventricular tachycardia occurred in 2 patients in Group 1 vs. none in Group 2 (P=ns). It did not require any specific treatment except the interruption of ibutilide infusion.

CONCLUSION: Both ibutilide and ATP proved to be safe and effective for recent onset type I AFL termination, but ibutilide was more effective when the arrhythmia had lasted longer than 48 h.

Key Words: atrial flutter, ibutilide, transoesophageal atrial pacing

*Corresponding author. Viale di Villa Pamphili, 37, 00152 Rome, Italy. Tel.: +39-06-5882564. E-mail address: gipulig{at}tin.it


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