Electrophysiological effects of ibutilide in patients with accessory pathways

Background-Atrial fibrillation (AF) may cause life-threatening ventricular arrhythmias in patients with Wolff-Parkinson-White syndrome. We prospectively evaluated the effects of ibutilide on the conduction system in patients with accessory pathways (AP). Methods and Results-In part I, we gave ibutilide to 22 patients (18 men, 31 +/-3 years of age) who had AF during electrophysiology study, including 6 pediatric patients less than or equal to 18 years of age. Ibutilide terminated AF in 21 of 22 patients (95%) during or 8 +/-5 minutes after infusion and prolonged the shortest preexcited R-R interval during AF. Successful ablation was performed in all patients. In part II, ibutilide was given to 18 patients ( 14 men, 28 +/- 21 years) to assess its effects on the AP and conduction system. Ibutilide prolonged the antegrade atrioventricular node effective refractory period (ERP) (from 252 +/- 60 to 303 +/- 70 ms; P <0.02). Ibutilide caused transient loss of the delta wave in 1 patient and abolished inducible tachycardia in 2 patients, although retrograde mapping still allowed for successful AP ablation. The antegrade AP ERP prolonged from 275 +/- 40 to 320 +/- 60 ms (P <0.01), as did the antegrade AP block cycle length; the retrograde AP ERP and block cycle length similarly prolonged with ibutilide. The relative and effective refractory period of the His-Purkinje system increased in 61% of patients after ibutilide. There were no adverse side effects. Conclusions-We report the use of ibutilide in terminating AP-mediated AF, including the first report in the pediatric population. Ibutilide prolonged refractoriness of the atrioventricular node, His-Purkinje system, and AP.