Department of Cardiology, Konstantopoulio General Hospital, Athens, Greece.
Am J Cardiol. 2010 Sep 1;106(5):673-6. doi: 10.1016/j.amjcard.2010.04.020. Epub 2010 Jul 23.
Ibutilide is a class III antiarrhythmic agent indicated for cardioversion of atrial fibrillation and atrial flutter to sinus rhythm (SR). The most serious complication of ibutilide is torsades de pointes (TdP). Magnesium has been successfully used for the treatment of TdP, but its use as a prophylactic agent for this arrhythmia has not yet been established. The present study investigated whether high dose of magnesium would increase the safety and efficacy of ibutilide administration. A total of 476 patients with atrial fibrillation or atrial flutter who were candidates for conversion to SR were divided into 2 groups. Group A consisted of 229 patients who received ibutilide to convert atrial fibrillation or atrial flutter to SR. Group B consisted of 247 patients who received an intravenous infusion of 5 g of magnesium sulfate for 1 hour followed by the administration of ibutilide. Then, another 5 g of magnesium were infused for 2 additional hours. Of the patients in groups A and B, 154 (67.3%) and 189 (76.5%), respectively, were converted to SR (p = 0.033). Ventricular arrhythmias (sustained, nonsustained ventricular tachycardia, and TdP) occurred significantly more often in group A than in group B (7.4% vs 1.2%, respectively, p = 0.002). TdP developed in 8 patients (3.5%) in group A and in none (0%) in group B (p = 0.009). The administration of magnesium (despite the high doses used) was well tolerated. In conclusion, the administration of high doses of magnesium probably makes ibutilide a much safer agent, and magnesium increased the conversion efficacy of ibutilide.
伊布利特是一种 III 类抗心律失常药物，适用于将心房颤动和心房扑动转为窦性心律（SR）。伊布利特最严重的并发症是尖端扭转型室性心动过速（TdP）。镁已成功用于治疗 TdP，但尚未将其用作预防这种心律失常的药物。本研究旨在探讨高剂量镁是否会增加伊布利特给药的安全性和疗效。共有 476 例心房颤动或心房扑动患者候选转为 SR，分为 2 组。A 组 229 例患者接受伊布利特转复心房颤动或心房扑动为 SR。B 组 247 例患者接受静脉滴注 5 g 硫酸镁 1 小时，然后给予伊布利特。然后再静脉滴注 5 g 硫酸镁 2 小时。A 组和 B 组患者中，分别有 154 例（67.3%）和 189 例（76.5%）转为 SR（p=0.033）。A 组室性心律失常（持续、非持续室性心动过速和 TdP）发生率明显高于 B 组（分别为 7.4%和 1.2%，p=0.002）。A 组 8 例（3.5%）患者出现 TdP，B 组无患者发生（0%，p=0.009）。给予镁（尽管剂量较高）后耐受性良好。总之，高剂量镁的应用可能使伊布利特更安全，且镁增加了伊布利特的转复效果。
