Comparison of Direct Current Synchronized Cardioversion to Ibutilide-Guided Catheter Ablation for Long-Term Sinus Rhythm Maintenance After Isolated Pulmonary Vein Isolation of Persistent Atrial Fibrillation

The American Journal of Cardiology
Maojing WangShanglang Cai

Abstract

Use of the antiarrhythmic ibutilide after isolated pulmonary vein isolation (PVI) might distinguish atrial remodeling severity and cases requiring further substrate modification, thereby improving efficacy of persistent atrial fibrillation (AF) treatment. Ninety-six consecutive patients with persistent AF were randomized after PVI to either direct current synchronized cardioversion (DCC group, n = 48) or 1 mg of intravenous ibutilide (ibutilide group, n = 48) followed by no further intervention if AF converted to sinus rhythm (SR) within 30 minutes (ibutilide conversion subgroup) or by complex fractionated atrial electrogram (CFAE) ablation until SR recovery or complete CFAE elimination (ibutilide nonconversion subgroup). With similarly distributed baseline characteristics and no serious postablation complications, the primary end point of 12-month SR maintenance rate after PVI was significantly higher for ibutilide versus the DCC group before (75% vs 56%; p = 0.042) or after (83% vs 60%; p = 0.011) reablation at physician's discretion for recurrence beyond 3 months after PVI. After ibutilide administration, 21 of 48 patients (44%) converted to SR at 17 ± 8 minutes (mean ± SD); those in the ibutilide nonconversion subgroup had ...Continue Reading

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