Recently, about one month ago, I had the opportunity to administer a drug that I had never heard of before with a middle aged lady in her fifties. She presented to me with a Rapid Ventricular Rate (RVR) or rapid heart rate and was in Atrial Fibrillation.
I had received word that the cardiologist would be accompanying her and that I was going to need to prepare this lady for cardio-version. Automatically, I’m thinking Conscious Sedation with Versed and Fentanyl because I was assuming that I was going to have administer drugs for Conscious Sedation on her while the Cardiologist zapped her with electrical shock; which turned out to not to be the case at all.
Three doctors arrived shortly after this lady arrived; a Cardiologist, Resident, and an Intern. The Cardiologist asked if the drugs she ordered where here yet. My response was, if you mean the Versed and Fentanyl, I have it ready to sedate her with. No, said the Cardiologist; we are not going to do that. I’m going to show you a trick that very few ever do or even know about.
I’m now thinking – ok, this will be something new for me because I thought I had seen or done it all at one time or another. In short, I was astonished at what I witnessed on my monitors as I seen all kinds of electrical activity in this lady’s heart transpire over a fifteen minute period and she converted back into Normal Sinus Rhythm in approximately 15 minutes and never felt one thing. In fact, she laid and watched herself on the monitor, as we four also did as I administered the drug very slowly.
The name of the drug is Corvert (ibutilide). Ibutilide is an anti-arrhythmic heart medication that corrects irregular heart rhythms like Atrial Fibrillation or Atrial Flutter. However, in some cases, ibutilide may not work on some patients, or your hearts irregular rhythm may occur again or even get worse after you’re treated with ibutilide. This is more likely to happen if you are also suffering from conditions such as Congestive Heart Failure (CHF).
Ibutilide is administered directly into the vein at a very slow rate (0.1mg/min) due to it concentration. Ibutilide comes in 1mg vials of 10mL or (10mL/1mg). The entire 1mg is given very slowly over a course of 10 minutes (0.1mg/min). If the patient does not convert back into normal rhythm, wait 10 minutes and you may repeat another 1mg dosage over another 10 minutes; again only giving 0.1mg/min over 10 minutes or until the patient converts to Normal Sinus Rhythm (NSR).
Nevertheless, this procedure should never be attempted unless there are knowledgeable doctors (preferably a cardiologist) at the bedside and you are watched closely with heart monitoring equipment so that in the event other problems occur, they can be treated quickly. In addition, you should be monitored with cardiac monitoring equipment for several hours after the procedure to ensure no further complications arise.
There are some other minor issues that may need to be addressed before using ibutilide; for example, your Potassium should be greater than or equal to 4.0 with specific readings with your Coagulation studies.
As I said, this was a first for me; and, I was amazed to see the Electrophysiology I witness transpire over a 15 minute period without any discomfort to the patient whatsoever with this drug ibutilide (Corvert).
Just a tidbit of information that may help you if you or someone you may know suffers from Atrial Fibrillation and / or Atrial Flutter; have them speak to their doctor or cardiologist about the use of ibutilide for cardio-version.
Teddie Joe Snodgrass, RN, MBA