title: The modified stepwise ablation guided by low-dose ibutilide in chronic atrial fibrillation trial (The MAGIC-AF Study).
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  ClinicalTrials.gov number: NCT01014741.
authors: Schulich Heart Program, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada.
authors: Sheldon M
authors: SM
authors: Singh
authors: Helmsley Cardiac Arrhythmia Service, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, PO Box 1030, New York, NY 10029, USA Instituto de Pesquisa em Arritmia Cardiaca, Florianopolis, South Carolina, Brazil.
authors: Andre
authors: A
authors: d'Avila
authors: Cardiovascular Division, Korea University Medical Center, Seoul, Korea.
authors: Young-Hoon
authors: YH
authors: Kim
authors: Mercy General Hospital, Dignity Health Heart & Vascular Institute, Sacramento, CA, USA.
authors: Arash
authors: A
authors: Aryana
authors: Cardiovascular Medicine, University of Virginia, Charlottesville, VA, USA.
authors: J Michael
authors: JM
authors: Mangrum
authors: Cardiovascular Division, Brigham and Women's Hospital, Harvard University, Boston, MA, USA.
authors: Gregory F
authors: GF
authors: Michaud
authors: Helmsley Cardiac Arrhythmia Service, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, PO Box 1030, New York, NY 10029, USA.
authors: Srinivas R
authors: SR
authors: Dukkipati
authors: Al-Sabah Arrhythmia Institute, Mount Sinai St Luke's-Roosevelt Hospital, New York, NY, USA.
authors: Conor D
authors: CD
authors: Barrett
authors: Heart Center, Massachusetts General Hospital, Boston, MA, USA.
authors: E Kevin
authors: EK
authors: Heist
authors: Helmsley Cardiac Arrhythmia Service, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, PO Box 1030, New York, NY 10029, USA.
authors: Michael K
authors: MK
authors: Parides
authors: Dalla Lana School of Public Health, Keenan Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, University of Toronto, Toronto, ON, Canada.
authors: Kevin E
authors: KE
authors: Thorpe
authors: Helmsley Cardiac Arrhythmia Service, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, PO Box 1030, New York, NY 10029, USA vivek.reddy@mountsinai.org.
authors: Vivek Y
authors: VY
authors: Reddy
mesh_terms: D001281:Atrial Fibrillation / Q000188:drug therapy*; D017115:Catheter Ablation; D002908:Chronic Disease; D022062:Electrophysiologic Techniques, Cardiac; D006801:Humans; D011667:Pulmonary Veins; D013449:Sulfonamides / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D013449:Sulfonamides; C067192:ibutilide
keywords: Arrhythmia; Atrial fibrillation; Catheter ablation; Electrophysiology; Mapping