ECG Diagnosis: Ibutilide-induced Torsade de Pointes

Ibutilide is recommended by professional society guidelines for the cardioversion of atrial fibrillation and flutter.1,2 Its rapid effect and minimal impact on hemodynamics make it well suited for use in the Emergency Department (ED).3 Ibutilide, however, prolongs the corrected QT (QTc) interval and increases risk for ventricular tachycardia (VT).4–6 The risk of VT can be greatly mitigated by careful selection of low-risk patients, the optimal dose of prophylactic magnesium sulfate, and at least 4 hours of postibutilide electrocardiographic monitoring.3 This case illustrates the dangers of overlooking ibutilide contraindications and provides practical lessons in ibutilide use and management of ibutilide-induced VT