An ibutilide-guided dynamic ablation strategy achieved a 73.9% AF-free survival rate with PVI alone in responders, compared to 60.7% in non-responders requiring additional linear ablation (P=0.070).
Cohort (n=367)
No
Does an ibutilide-guided ablation strategy help tailor the extent of ablation and predict recurrence in patients with persistent atrial fibrillation?
Using ibutilide response to guide ablation in persistent AF may identify patients who only require pulmonary vein isolation, reducing ablation extent without compromising efficacy.
Absolute Event Rate: 73.9% vs 60.7%
p-value: p=0.070
BACKGROUND: Persistent atrial fibrillation (PsAF) ablation faces a dilemma between insufficient pulmonary vein isolation (PVI) leading to high recurrence and excessive ablation increasing complications without clear benefit. Ibutilide may help identify critical ablation targets by modifying the arrhythmia substrate. METHODS: This retrospective single-center study analyzed 367 PsAF patients undergoing ibutilide-guided ablation. After PVI, patients converting directly to sinus rhythm (SR) (PVI group, n = 86) received no further ablation. Non-responders (PVI+Linear group, n = 281) underwent linear ablation and were categorized by acute termination pattern: Directly to SR (n = 109), AFL to SR (n = 87), DC to SR (n = 75), or Failure (n = 10). Subgroups based on low-voltage areas (LVZs) and AF duration were analyzed. AF recurrence (> 30s post 3-month blanking period) was assessed. RESULTS: Over a mean follow-up, AF-free survival rate was non-significantly higher in the PVI group vs. PVI+Linear group ((73.9% vs. 60.7%, P = 0.070). In the PVI+Linear group, success rates differed significantly by acute termination pattern (Direct to SR:67.8%, AFL to SR:72.6%, DC to SR:26.4%, Failure to SR:30.0%, P < 0.001), LVZs presence (Absent:63.8% vs. Present:55.8%, P < 0.001), and AF duration (≤ 1 year:73.9%, 1-5 year:55.3%, ≥ 5 year:44.6%, P < 0.001). Female, larger LA diameter, longer AF duration, and DC/Failure termination patterns independently predicted recurrence. CONCLUSION: The use of ibutilide may help identify "PVI‑sensitive" atrial fibrillation, reducing the extent of ablation without compromising efficacy.Female sex, LA enlargement, prolonged AF duration, and requiring DC/failing to terminate acutely predict recurrence.
Hu et al. (Wed,) conducted a cohort in Persistent atrial fibrillation (n=367). Ibutilide-guided dynamic ablation (PVI alone) vs. PVI + linear ablation was evaluated on AF-free survival (p=0.070). An ibutilide-guided dynamic ablation strategy achieved a 73.9% AF-free survival rate with PVI alone in responders, compared to 60.7% in non-responders requiring additional linear ablation (P=0.070).