Anyone use ibutilide?

[JohnW]

We used this drug in my SICU the other day (per cardiology) for a paitent who had ended up in Afib/Afluuter. The paient, who was in his 20s, was given concentrated IVP neo (by mistake) in the OR. He dropped his HR down to 30 and was given atropine. He came out to Us (direct admit) in RAF. We gave him the Ibutilide and had a ton of ectopy while the med was infusion. He then flipped into sinus and all the ectopy stopped. We kept him for 10hrs or so checking his QTc (we were doing 1 hr EKGs for a while) and then dc'd him to home.

Anyone very familiar with the drug? I'd love some feedback, tips, what to expect type information?

Thanks!!

[JumpNurse]

We used it all the time when I worked CV/CICU. It is known to cause quite a bit of ventricular ectopy, esp Torsades des Pointes. We usually gave 1-2grams MagSulfate empiricly for this reason. You are right about monitoring QT intervals as they can lengthen with administration. Generally we only got a before and after EKG, but there had to be connected to a crash cart in case of prolonged ventricular ectopy.

Administration was usually 1mg over 10mins and repeat once if not effective. Hope this helps

[diveRN]

Corvert is a good drug when used appropriately and with corrected lytes. Our facility uses hospitalists mostly and those that don't specialize generally don't know much about the drug and won't order it even when asked.

Even though it's not diagnostic, many of the more progressive cardiac docs I've seen using Covert will do a carotid massage before it's prescribed on age appropriate pts. In watching this, I've found that if the carotid massage precipitates even a short-lived decrease in HR, then the drug often converts the arrhythmia. If the massage doesn't lower the HR, they generally won't order it.

Just my observation.