The Modified Ablation Guided by Ibutilide Use in Chronic Atrial Fibrillation (MAGIC-AF) Study: clinical background and study design.
BACKGROUND
Beyond pulmonary vein isolation (PVI), adjuvant ablation at the sites of complex fractionated atrial electrograms (CFAE) has been shown to improve the long-term success of catheter ablation of persistent atrial fibrillation (AF). However, this approach often requires extensive ablation due to the widespread distribution of CFAE within the left atrium. An optimal strategy would identify areas of CFAE which, when selectively targeted with ablation, result in AF termination with an acceptable long-term freedom from AF. It is possible that the intraprocedural administration of an antiarrhythmic drug may help accomplish this.


OBJECTIVE
The Modified Ablation Guided by Ibutilide Use in Chronic AF (MAGIC-AF) Study is an international multicenter prospective randomized double-blinded clinical trial assessing the utility of the intraprocedural administration of 0.25 mg of intravenous ibutilide before performing CFAE ablation. The primary efficacy endpoint of this study will be the freedom from AF at 1 year after a single procedure off antiarrhythmic agents. Safety endpoints will include procedural and radiofrequency ablation time as well as overall procedural complication rate.


METHODS
Patients undergoing a first ever catheter ablation procedure for persistent AF will be included. Individuals with hypertrophic cardiomyopathy, complex congenital heart disease including atrial septal defects, and ejection fraction <35% will be excluded from the study. All patients will first undergo PVI. Those patients who remain in AF will then be randomized in a 1:1 fashion to receive either 0.25 mg intravenous ibutilide or saline placebo followed by a CFAE based ablation strategy. Two hundred randomized patients will be enrolled in this study-100 in each study arm.


CONCLUSIONS
The MAGIC-AF study will assess the utility of a combined pharmaco-ablative strategy in patients with persistent AF undergoing a CFAE based ablation strategy.
Schulich Heart Program, Division of Cardiology, Sunnybrook Health Science Center, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Sheldon M
SM
Singh
Andre
A
D'Avila
Young-Hoon
YH
Kim
Arash
A
Aryana
J Michael
JM
Mangrum
Gregory F
GF
Michaud
Srinivas R
SR
Dukkipati
David J
DJ
Callans
Conor D
CD
Barrett
Maximo R
MR
Beras-Jovine
Vivek Y
VY
Reddy
D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D002170:Canada; D017115:Catheter Ablation / Q000009:adverse effects; D002908:Chronic Disease; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D022062:Electrophysiologic Techniques, Cardiac; D006801:Humans; D007262:Infusions, Intravenous; D008279:Magnetic Resonance Imaging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery; D012008:Recurrence; D056910:Republic of Korea; D012107:Research Design; D013449:Sulfonamides / Q000008:administration & dosage*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014481:United States
D000889:Anti-Arrhythmia Agents; D013449:Sulfonamides; C067192:ibutilide