The modified stepwise ablation guided by low-dose ibutilide in chronic atrial fibrillation trial (The MAGIC-AF Study)

Sheldon M. Singh, Andre D'Avila, Young Hoon Kim, Arash Aryana, J. Michael Mangrum, Gregory F. Michaud, Srinivas R. Dukkipati, Conor D. Barrett, E. Kevin Heist, Michael K. Parides, Kevin E. Thorpe, Vivek Y. Reddy

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Aims 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. Methods and results 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. Conclusion 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. Clinical trial registration information ClinicalTrials.gov number: NCT01014741. Published on behalf of the European Society of Cardiology. All rights reserved.

Original languageEnglish (US)
Pages (from-to)1614-1621
Number of pages8
JournalEuropean Heart Journal
Volume37
Issue number20
DOIs
StatePublished - May 21 2016
Externally publishedYes

Fingerprint

Cardiac Electrophysiologic Techniques
Atrial Fibrillation
Placebos
Cardiac Arrhythmias
ibutilide
Catheter Ablation
Pulmonary Veins
Anti-Arrhythmia Agents
Fluoroscopy
Maintenance
Clinical Trials

Keywords

  • Arrhythmia
  • Atrial fibrillation
  • Catheter ablation
  • Electrophysiology
  • Mapping

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Singh, S. M., D'Avila, A., Kim, Y. H., Aryana, A., Mangrum, J. M., Michaud, G. F., ... Reddy, V. Y. (2016). The modified stepwise ablation guided by low-dose ibutilide in chronic atrial fibrillation trial (The MAGIC-AF Study). European Heart Journal, 37(20), 1614-1621. https://doi.org/10.1093/eurheartj/ehw003

The modified stepwise ablation guided by low-dose ibutilide in chronic atrial fibrillation trial (The MAGIC-AF Study). / Singh, Sheldon M.; D'Avila, Andre; Kim, Young Hoon; Aryana, Arash; Mangrum, J. Michael; Michaud, Gregory F.; Dukkipati, Srinivas R.; Barrett, Conor D.; Heist, E. Kevin; Parides, Michael K.; Thorpe, Kevin E.; Reddy, Vivek Y.

In: European Heart Journal, Vol. 37, No. 20, 21.05.2016, p. 1614-1621.

Research output: Contribution to journalArticle

Singh, SM, D'Avila, A, Kim, YH, Aryana, A, Mangrum, JM, Michaud, GF, Dukkipati, SR, Barrett, CD, Heist, EK, Parides, MK, Thorpe, KE & Reddy, VY 2016, 'The modified stepwise ablation guided by low-dose ibutilide in chronic atrial fibrillation trial (The MAGIC-AF Study)', European Heart Journal, vol. 37, no. 20, pp. 1614-1621. https://doi.org/10.1093/eurheartj/ehw003
Singh, Sheldon M. ; D'Avila, Andre ; Kim, Young Hoon ; Aryana, Arash ; Mangrum, J. Michael ; Michaud, Gregory F. ; Dukkipati, Srinivas R. ; Barrett, Conor D. ; Heist, E. Kevin ; Parides, Michael K. ; Thorpe, Kevin E. ; Reddy, Vivek Y. / The modified stepwise ablation guided by low-dose ibutilide in chronic atrial fibrillation trial (The MAGIC-AF Study). In: European Heart Journal. 2016 ; Vol. 37, No. 20. pp. 1614-1621.
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abstract = "Aims 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. Methods and results 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. Conclusion 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. Clinical trial registration information ClinicalTrials.gov number: NCT01014741. Published on behalf of the European Society of Cardiology. All rights reserved.",
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AU - Aryana, Arash

AU - Mangrum, J. Michael

AU - Michaud, Gregory F.

AU - Dukkipati, Srinivas R.

AU - Barrett, Conor D.

AU - Heist, E. Kevin

AU - Parides, Michael K.

AU - Thorpe, Kevin E.

AU - Reddy, Vivek Y.

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N2 - Aims 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. Methods and results 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. Conclusion 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. Clinical trial registration information ClinicalTrials.gov number: NCT01014741. Published on behalf of the European Society of Cardiology. All rights reserved.

AB - Aims 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. Methods and results 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. Conclusion 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. Clinical trial registration information ClinicalTrials.gov number: NCT01014741. Published on behalf of the European Society of Cardiology. All rights reserved.

KW - Arrhythmia

KW - Atrial fibrillation

KW - Catheter ablation

KW - Electrophysiology

KW - Mapping

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