Class III medications

1. Amiodarone (Cordarone) does not appear to be effective in converting recent-onset atrial fibrillation to sinus rhythm. Oral amiodarone may be effective as an adjunct to DC cardioversion.

2. Sotalol (Betapace) is not useful for the acute termination of atrial fibrillation. Sotalol and amiodarone slow conduction and prolong refractoriness in the atrioventricular node and thus can control ventricular response to atrial fibrillation.

3. Ibutilide (Corvert) is an intravenous class III antiarrhythmic agent. It is indicated for the acute termination of atrial fibrillation and flutter. The half-life of ibutilide is three to six hours. Its clinical effect is gone in two to six hours. Ibutilide is administered in a dosage of 0.01 mg per kg intravenously over 10 minutes. Conversion rates are between 33-45%. If the first dose is ineffective, a second may be administered before alternative strategies are considered.

F. In summary, class IA and class IC agents are effective for acute termination of atrial fibrillation, with conversion rates of 60-80%. Although class III agents are useful as adjuncts to electric cardioversion and are effective in maintaining sinus rhythm, only ibutilide is useful for acute cardioversion.

References: See page 195.

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