What is strange about this paroxysmal atrial fibrillation in an otherwise healthy patient? And what happened after giving ibutilide?

Conclusions.The efficacy of transthoracic cardioversion for converting atrial fibrillation to sinus rhythm was enhanced by pretreatment with ibutilide. However, use of this drug should be avoided in patients with very low ejection fractions. (N Engl J Med 1999;340:1849-54.) Smith comments from the full text: They included patients who had had a fib for less than 48 hours  They excluded patients with a fib for longer than 48 hours unless they proved, by TE echo, to not have an atrial thrombus OR unless they anti-coagulated them for 3 weeks first *Therefore, our patients who have been in afib< 48 hours, or who have been on anticoagulants, apply.  Theyexcluded anyone with aQTc> 480ms because ibutilide can lead to torsades.  The dose was 1mg over 10 minutes  In the 2 patients who went into torsades (both with low ejection fractions,<20%), both were easily controlled. The authors recommend not using ibutilide for this indication in stable patients if the EF is< 30%. However, it is still an option in unstable patients. Ibutilide increased the QTc significantly (432+/-37 before vs. 482+/-49 afterward) Although the point is not discussed in the paper, I would not send such a patient home unless the QT is no longer prolonged.==================================My Comment by KEN GRAUER, MD (2/11/2023):==================================I found today ’s case highly instructive in highlighting a number of importa...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs