Monday, July 11, 2022


Q: Which one intervention may decrease the risk of torsades de pointes with ibutilide? 

Answer: Pretreatment with intravenous (IV) magnesium 

Ibutilide is not very popular for use as chemical agent for cardioversion in acute atrial fibrillation. This is due to it's risk to cause torsades de pointes. A less known fact is that it is more effective to convert atrial flutter to sinus rhythm. Pretreatment with IV magnesium decreases the risk of ibutilide-induced torsades de pointes. Risk factors for ibutilide-induced torsades de pointes are heart failure, baseline prolong QTc interval, hypokalemia or hypomagnesemia. 

The dose of Ibutilide in average adult patient is 1 mg over 10 minutes. If no or partial response, a second bolus of 1 mg over 10 minutes can be used. 



1. Stambler BS, Wood MA, Ellenbogen KA, et al. Efficacy and safety of repeated intravenous doses of ibutilide for rapid conversion of atrial flutter or fibrillation. Ibutilide Repeat Dose Study Investigators. Circulation 1996; 94:1613.

2. Abi-Mansour P, Carberry PA, McCowan RJ, et al. Conversion efficacy and safety of repeated doses of ibutilide in patients with atrial flutter and atrial fibrillation. Study Investigators. Am Heart J 1998; 136:632.

3. Vinson DR, Lugovskaya N, Warton EM, Rome AM, Stevenson MD, Reed ME, Nagam MR, Ballard DW; Pharm CAFÉ Investigators of the CREST Network. Ibutilide Effectiveness and Safety in the Cardioversion of Atrial Fibrillation and Flutter in the Community Emergency Department. Ann Emerg Med. 2018 Jan;71(1):96-108.e2. doi: 10.1016/j.annemergmed.2017.07.481. Epub 2017 Sep 29. PMID: 28969929.

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