Abstract
Background In patients with persistent atrial fibrillation (AF), the procedural and clinical outcomes of ablation combined with infusion of antiarrhythmic drug are unknown. Objectives To determine the impact of low-dose ibutilide after circumferential pulmonary vein isolation (CPVI) and/or left atrial (LA) substrate modification on acute procedural and clinical outcome of persistent AF. Methods In a prospective cohort of 135 consecutive patients with persistent AF, intravenous 0.25 mg ibutilide was administered 3 days before the procedure and intraprocedurally, if required, after CPVI and/or additional LA substrate modification of sites with continuous, rapid or fractionated, and low-voltage (0.05–0.3 mv) atrial activity. Results Persistent AF was terminated by CPVI alone (n=15) or CPVI + ibutilide (n=32) in 47 (34.8%) patients (CPVI responders). Additional LA substrate modification without (n=33) or with subsequent administration of 0.25 mg ibutilide (n=19) terminated AF in another 52 (38.5%) patients (substrate modification responders). Sinus rhythm was restored by electrical cardioversion in the remaining 36 (26.7%) patients (nonresponders). The mean LA substrate ablation time was 14 ± 6 minutes. At follow-up of 24 ± 10 months, the rates of freedom from atrial tachyarrhythmias among the responders in CPVI and substrate modification groups were mutually comparable (66.0% and 69.2%) and higher than among the nonresponders (36.1%; P < 0.01). Among the responders, there was no difference in clinical outcome between patients whose persistent AF was terminated without or with low-dose ibutilide. Conclusion Administration of low-dose ibutilide during ablation of persistent AF may allow select patients wherein substrate ablation is not or minimally required to optimize procedural and clinical outcomes.
Highlights
Persistent atrial fibrillation (AF) represents a major challenge in catheter ablation of arrhythmias [1]
We found that 0.25 mg ibutilide significantly prolonged the AF cycle length (AFCL) by organizing atrial electrograms in several areas, possibly the bystander sites. e sites presenting continuous, rapid or low-voltage, and fractionated activity were regarded as key locations of AF drivers
During catheter ablation of persistent atrial fibrillation (AF), it is difficult to identify the key atrial substrate of AF because of the chaotic pattern of atrial activity in most patients. In this prospective study enrolling 135 patients with persistent AF, we have systematically tested the hypotheses that intraprocedural low-dose (0.25 mg) ibutilide would distinguish between the patients who will do well just with circumferential pulmonary vein isolation (CPVI) versus those who would require additional atrial substrate ablation
Summary
Persistent atrial fibrillation (AF) represents a major challenge in catheter ablation of arrhythmias [1]. In patients with persistent atrial fibrillation (AF), the procedural and clinical outcomes of ablation combined with infusion of antiarrhythmic drug are unknown. To determine the impact of low-dose ibutilide after circumferential pulmonary vein isolation (CPVI) and/or left atrial (LA) substrate modification on acute procedural and clinical outcome of persistent AF. In a prospective cohort of 135 consecutive patients with persistent AF, intravenous 0.25 mg ibutilide was administered 3 days before the procedure and intraprocedurally, if required, after CPVI and/or additional LA substrate modification of sites with continuous, rapid or fractionated, and low-voltage (0.05–0.3 mv) atrial activity. There was no difference in clinical outcome between patients whose persistent AF was terminated without or with low-dose ibutilide. Administration of low-dose ibutilide during ablation of persistent AF may allow select patients wherein substrate ablation is not or minimally required to optimize procedural and clinical outcomes
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