title: Termination of persistent atrial fibrillation during pulmonary vein isolation: insight from the MAGIC-AF trial.
abstract: OBJECTIVE
  Controversy on the optimal ablation strategy for persistent atrial fibrillation (AF) exists with limited work evaluating a strategy of pulmonary vein isolation (PVI) alone when AF terminates during PVI. Thirty-five patients had AF termination during PVI in the Modified Ablation Guided by Ibutilide Use in Chronic Atrial Fibrillation (MAGIC-AF; ClinicalTrials.gov number: NCT01014741) study. The objective of the current study is to report the 1-year outcome after PVI alone in this unique patient group.
  
  
  RESULTS
  The 1-year single procedure freedom from atrial arrhythmia off anti-arrhythmic drugs was reported for the 35 patients in the MAGIC-AF study with persistent AF termination during or upon completion of PVI. Freedom from recurrent atrial arrhythmia was achieved in 60% of patients where AF terminated during PVI. Cavotricuspid isthmus flutter was common when AF terminated to a macro re-entrant flutter during PVI, and responsible for 92% of all flutter circuits with AF termination.
  
  
  CONCLUSIONS
  Persistent AF termination during PVI may identify a subgroup of patients who experience a similar long-term clinical outcome with PVI ablation alone when compared with other more extensive persistent AF ablation strategies. Pulmonary vein isolation alone may be an appropriate tactic in this subgroup of persistent AF patients.
authors.affiliation: Schulich Heart Program, Sunnybrook Health Science Center, Faculty of Medicine, University of Toronto, Toronto, Canada.
authors.forename: Sheldon M
authors.initials: SM
authors.lastname: Singh
authors.affiliation: Helmsley Cardiac Arrhythmia Service, Icahn School of Medicine at Mount Sinai, New York, NY, USA.|Instituto de Pesquisa em Arritmia Cardiaca - Hospital Cardiologico, Florianopolis, SC, Brazil.
authors.forename: Andre
authors.initials: A
authors.lastname: d'Avila
authors.affiliation: Cardiovascular Division, Korea University Medical Center, Seoul, Republic of Korea.
authors.forename: Young-Hoon
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, CA, USA.
authors.forename: Arash
authors.initials: A
authors.lastname: Aryana
authors.affiliation: Cardiovascular Medicine, University of Virginia, Charlottesville, VA, USA.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Mangrum
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Harvard University, Boston, MA, USA.
authors.forename: Gregory F
authors.initials: GF
authors.lastname: Michaud
authors.affiliation: Helmsley Cardiac Arrhythmia Service, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Srinivas R
authors.initials: SR
authors.lastname: Dukkipati
authors.affiliation: Heart Center, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Conor D
authors.initials: CD
authors.lastname: Barrett
authors.affiliation: Heart Center, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: E Kevin
authors.initials: EK
authors.lastname: Heist
authors.affiliation: Helmsley Cardiac Arrhythmia Service, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Parides
authors.affiliation: Dalla Lana School of Public Health, Keenan Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, University of Toronto, Toronto, Canada.
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Thorpe
authors.affiliation: Helmsley Cardiac Arrhythmia Service, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Vivek Y
authors.initials: VY
authors.lastname: Reddy
mesh_terms: D000200:Action Potentials; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001282:Atrial Flutter / Q000209:etiology; D002170:Canada; D017115:Catheter Ablation / Q000009:adverse effects; D018572:Disease-Free Survival; D004311:Double-Blind Method; D015716:Electrocardiography, Ambulatory; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012042:Registries; D056910:Republic of Korea; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Arrhythmia; Atrial fibrillation; Catheter ablation; Electrophysiology