Friday December 22, 2006
Ibutalide (Corvert)

Use of Ibutalide has practically became non-existent due to fear of provoking torsades de pointes. It is true that 4% of patients may develop torsades de pointes but still it is a very useful drug to convert atrial flutter or fibrillation of recent onset. It has a very high rate of chemical cardioversion.

Consider a situation where you have "only chemical code" patient who has gone into acute atrial fibrillation with severe hemodynamic instabilty. Amiodarone may not be a perfect choice as a chance of cardioversion with amiodarone is only 5% and overall it is a good drug for rate control instead of cardioversion. Moreover, bolus of amiodarone may dips down blood pressure further. Point is - intensivists need to be aware of this drug as a backup when all other options are exhausted.

The usual dose of ibutilide is 1 mg followed by another dose if the first one is not effective.