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Updated: Sep 20, 2025

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

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Cardioversion of Post-Ablation Atrial Tachyarrhythmia with Ibutilide and Amiodarone: A Registry-Based Cohort Study

Filippo Cacioppo1, Michael Schwameis1, Nikola Schuetz1

  • 1Medical University of Vienna, Department of Emergency Medicine, Waehringer Guertel 18-20, 1090 Vienna, Austria.

International Journal of Environmental Research and Public Health
|June 10, 2022
PubMed

Insights

Ibutilide demonstrated significantly higher success in restoring normal heart rhythm compared to amiodarone for patients experiencing recurrent atrial tachyarrhythmia post-ablation. This finding suggests ibutilide may be a more effective treatment option for these complex cases.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Pharmacology

Background:

  • A growing number of patients experience recurrent atrial tachyarrhythmia after catheter ablation for atrial fibrillation or atrial flutter.
  • Limited study-driven treatment recommendations exist for this patient population.
  • Effective cardioversion strategies are crucial for managing post-ablation arrhythmias.

Purpose of the Study:

  • To compare the cardioversion success rates of ibutilide and amiodarone in patients with post-ablation atrial tachyarrhythmia.
  • To evaluate the efficacy of these antiarrhythmic drugs in restoring sinus rhythm.
  • To analyze conversion rates stratified by specific arrhythmia types.

Main Methods:

  • Retrospective analysis of 109 episodes of post-ablation atrial tachyarrhythmia in 72 patients treated with intravenous ibutilide or amiodarone (2010-2018).
  • Primary endpoint: conversion to sinus rhythm.
  • Multivariable cluster-adjusted logistic regression used to compare cardioversion success between ibutilide and amiodarone.

Main Results:

  • Overall conversion rates were 76% for ibutilide (37/49 episodes) and 27% for amiodarone (16/60 episodes).
  • Ibutilide was associated with significantly higher odds of conversion compared to amiodarone (OR 5.6, 95% CI 1.3-24.3).
  • Ibutilide showed the highest efficacy in atrial flutter and focal atrial tachycardia, with notable success in atrial fibrillation.

Conclusions:

  • Ibutilide is associated with a significantly higher success rate for cardioversion of post-ablation atrial tachyarrhythmia compared to amiodarone.
  • The findings suggest ibutilide may be a preferred agent for rhythm control in this specific patient group.
  • Randomized controlled trials are necessary to validate these findings and establish definitive treatment guidelines.

Keywords:
AmiodaroneIbutilidecatheter ablationsupraventriculartachycardia

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