A 79-year-old woman with a history of hypertension, angina, and heart failure was presented to the emergency department with exacerbation of heart failure. She was on following medications before admission that included metoprolol, digoxin, nitroglycerin, and aspirin. After admission, she complained of pleuritic pain radiating to the left arm and neck. She became tachypnoeic with a blood pressure of 100/52 mm Hg and heart rate of 82 beats/min.
Ibutilide (1 mg) was administered intravenously over 10 minutes for conversion of atrial fibrillation to sinus rhythm, which occurred 10 minutes after infusion (52 beats/min). The patient immediately complained of hot flushes. Over the subsequent 17 minutes, she experienced 19 distinct episodes of sinus arrest (mean duration 3.1 seconds, range 2.2–4.5) (image attached). During these episodes, blood pressure ranged from 103–88/65–51 mm Hg, and…
