Ibutilide Pretreatment to Facilitate Cardioversion of Refractory Atrial Fibrillation in a Patient with Morbid Obesity


  • Mark H Friesen Health Sciences Centre
  • John Ducas Health Sciences Centre





Electrical cardioversion is an effective means for converting atrial fibrillation to normal sinus rhythm, with conversion rates ranging from 70% to 90%.1 There are a number of treatment alternatives for patients with atrial fibrillation that is refractory to conventional monophasic electrical cardioversion, including external biphasic shock, pretreatment with antiarrhythmic medication, high-energy monophasic shocks, and internal cardioversion. External biphasic shock is becoming the standard of care in the electrical cardioversion of atrial fibrillation.2 However, even with this modality, atrial fibrillation is resistant to cardioversion in a small proportion of patients. In this setting, use of antiarrhythmic (class III) medication to facilitate cardioversion may be an attractive approach.1 This report describes the use of ibutilide for atrial fibrillation refractory to cardioversion with both amiodarone and biphasic shock. This case is also important because of the role that obesity played in the patient’s recurrent/resistant atrial fibrillation and in the pharmacokinetics of antiarrhythmic agents.


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Case Report(s) / Observation(s) clinique(s)