The modified stepwise ablation guided by low-dose ibutilide in chronic atrial fibrillation trial (The MAGIC-AF Study)

Sheldon M. Singh, Andre D'Avila, Young Hoon Kim, Arash Aryana, J. Michael Mangrum, Gregory F. Michaud, Srinivas R. Dukkipati, Conor D. Barrett, E. Kevin Heist, Michael K. Parides, Kevin E. Thorpe, Vivek Y. Reddy

    Research output: Contribution to journalArticlepeer-review

    15 Citations (Scopus)

    Abstract

    Aims Complex fractionated atrial electrograms (CFAE) are targeted during persistent atrial fibrillation (AF) ablation. However, many CFAE sites are non-specific resulting in extensive ablation. Ibutilide has been shown to reduce left atrial surface area exhibiting CFAE. We hypothesized that ibutilide administration prior to CFAE ablation would identify sites critical for persistent AF maintenance allowing for improved procedural efficacy and long-term freedom from atrial arrhythmias. Methods and results Two hundred patients undergoing a first-ever persistent AF catheter ablation procedure were randomly assigned to receive either 0.25 mg of intravenous ibutilide or saline placebo upon completion of pulmonary vein isolation. Complex fractionated atrial electrogram sites were then targeted with ablation. The primary efficacy endpoint was the 1-year single procedure freedom from atrial arrhythmia off anti-arrhythmic drugs. Similar procedural characteristics (procedure, fluoroscopy, and ablation times) were observed with both strategies despite a greater reduction in left atrial surface area with CFAE sites (8 vs. 1%, P < 0.0001) and AF termination during CFAE ablation with ibutilide compared with placebo (75 vs. 57%, P = 0.007). The primary efficacy endpoint was achieved in 56% of patients receiving ibutilide and 49% receiving placebo (P = 0.35). No significant differences in peri-procedural complications were observed in both groups. Conclusion Despite a reduction in CFAE area and greater AF termination during CFAE ablation, procedural characteristics and clinical outcomes were unchanged when CFAE ablation was guided by ibutilide administration. Clinical trial registration information ClinicalTrials.gov number: NCT01014741. Published on behalf of the European Society of Cardiology. All rights reserved.

    Original languageEnglish
    Pages (from-to)1614-1621
    Number of pages8
    JournalEuropean heart journal
    Volume37
    Issue number20
    DOIs
    Publication statusPublished - 2016 May 21

    Bibliographical note

    Publisher Copyright:
    © The Author 2016.

    Keywords

    • Arrhythmia
    • Atrial fibrillation
    • Catheter ablation
    • Electrophysiology
    • Mapping

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine

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