Individualized dynamic ablation strategy for persistent atrial fibrillation based on ibutilide response.

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Persistent atrial fibrillation (PsAF) ablation is challenged by recurrence risk and excessive ablation complications.
• Pulmonary vein isolation (PVI) alone may be insufficient for PsAF.
• Ibutilide can modify the arrhythmia substrate, potentially identifying critical ablation targets.

Purpose of the Study:

• To evaluate the efficacy of ibutilide-guided ablation in PsAF patients.
• To determine if ibutilide can help reduce ablation extent without compromising outcomes.
• To identify predictors of recurrence in PsAF ablation.

Main Methods:

• Retrospective analysis of 367 PsAF patients undergoing ibutilide-guided ablation.
• Patients were categorized into PVI-only or PVI+Linear ablation groups based on response to ibutilide.
• Acute termination patterns, low-voltage zones (LVZs), and AF duration were analyzed for recurrence prediction.

Main Results:

• AF-free survival was non-significantly higher in the PVI group (73.9%) vs. PVI+Linear group (60.7%).
• Success rates in the PVI+Linear group varied significantly by termination pattern, LVZ presence, and AF duration.
• Female sex, larger LA diameter, longer AF duration, and specific termination patterns independently predicted recurrence.

Conclusions:

• Ibutilide may identify
• PVI-sensitive
• atrial fibrillation, potentially reducing ablation extent.
• Female sex, LA enlargement, prolonged AF duration, and specific acute termination patterns are independent predictors of recurrence.
• Ibutilide-guided ablation offers a strategy for personalized treatment in PsAF.