Therapy

• ibutilide ^a  

Why?

• Ibutilide is more effective at cardioversion than procainamide ^a , sotalol ^a , or placebo ^a
• However it increases the risk of ventricular tachycardias ^a but still causes fewer overall adverse effects than procainamide ^a

Ibutilide is effective at cardioversion, but cause ventricular tachycardia

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
recent onset AF or flutter a	ibutilide	placebo	sinus rhythm at 1.5 hours	2.5%	1800% (380% to 7400%)	2 (2 to 3)
			polymorphic VT at 24 hours	0.0%		-11 (-21 to -7)
recent onset AF or flutter a	ibutilide	procainamide	sinus rhythm at 24 hours	18%	220% (79% to 470%)	3 (2 to 4)
			adverse effects	47%	39% (1% to 63%)	5 (3 to 76)
recent onset AF or flutter a	ibutilide	sotalol	sinus rhythm at 60 minutes	11%	65% (33% to 82%)	5 (3 to 9)