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Antiarrhythmic and Electrophysiologic Effects of Intravenous Ibutilide and Sotaloi in the Canine Sterile Pericarditis Model
Author(s) -
BUCHANAN LEWIS V.,
May RICHELLE J.,
WALTERS RODNEY R.,
HSU CHANGYUAN L.,
BRUNDEN MARSHAL N.,
GIBSON JOHN K.
Publication year - 1996
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.1996.tb00506.x
Subject(s) - ibutilide , medicine , cardiology , anesthesia , pericarditis , atrial fibrillation , atrial flutter
Ibutilide, Sotalol, and Atrial Flutter. Introduction : Atrial arrhythmias are a frequent clinical complication following open heart surgery. We compared the Class III agents d,I‐sotalol and ibutilide fumarate in an intravenous cross‐over study using the canine atrial sterile pericarditis model. Methods and Results : We studied pacing‐induced sustained atrial flutter over a 7‐day post‐surgical period in conscious dogs, alternating analysis of ibutilide (1.0 to 30.0 μg/kg) and d,I‐sotalol (0.1 to 3.0 mg/kg). Ibutilide significantly increased atrial flutter cycle length (AFL CL) II ± 2 msec and atrial effective refractory period (AERP) 13 ± 2 msec, and terminated atrial flutter in all cases (n = 12) following a mean dose of 6 ± 2 μg/kg. Plasma concentrations of ibutilide were 53 ± 13 ng/mL. Ventricular effective refractory period (VERP) was not signiflcantly affected (4 ± 2 msec). Following termination with ibutilide, atrial flutter could he reinitiated in 1 of 12 trials, and was nonsustained (40‐sec duration). Sotalol significantly increased AFL CL 23 ± 3 msec and terminated atrial flutter in 8 of 12 trials following a mean dose of 1.5 ± 0.4 mg/kg. AERP and VERP were significantly increased 20 ± 6 and 12 ± 2 msec, respectively. The incidence of reinduced atrial flutter was 9 of 12 trials (P ≥ 0.05 vs ibutilide) (7 nonsustained 57 ± 7 sec duration, and 2 sustained). Sotalol failed to terminate atrial flutter in two dogs on days 1 and 5, despite increases in AFL CL (21 ± 8 msec) and AERP (16 ± 9 msec), whereas on day 3, ibutilide (20 ± 7 μg/kg) terminated atrial flutter in those two dogs while increasing AFL CL and AERP 18 ± 6 and 15 ± 0 msec, respectively. Conclusion : Both sotalol and ibutilide terminate atrial flutter in this model. Ibutilide converted atrial flutter in dogs in which sotalol was not successful. Following atrial flutter termination, ibutilide had a lower incidence of reinduced arrhythmias compared to sotalol. Ibutilide produced atrial antiarrhythmic effects while having no significant electrophysiologic effects on the ventricle.