Low-dose Ibutilide Helps ID AFib Patients In Whom Pulmonary Vein Isolation Works

Low-dose ibutilide was useful in identifying patients with persistent atrial fibrillation (AFib) in whom pulmonary vein isolation was shown effective as a sole therapy, new study results suggest.

“Circumferential pulmonary vein isolation can be effective as sole treatment for persistent atrial fibrillation,” the authors wrote. “However, identifying those patients who will respond to this therapy remains a challenge.”

The authors looked specifically at the clinical value of sequential low-dose ibutilide testing to identify those with persistent AFib and in whom pulmonary vein isolation was effective by itself as a sole therapy. The prospective cohort consisted of 180 consecutive patients with persistent AFib. Patients were given intravenous low-dose (0.004 mg/kg) ibutilide three days prior to ablation and again after completion of pulmonary vein isolation. Patients in whom the pre-procedural ibutilide did not stop AFib, but did stop it during the procedure, did not have additional atrial substrate modification.

The authors reported that pre-procedural ibutilide did not terminate arrhythmia in patients with persistent AFib, but the combination of pulmonary vein isolation and ibutilide stopped AFib in 55 (30.6%) patients (PsAF group 1). For the remaining patients, electrogram-based ablation was performed (n=125; PsAF group 2). Patients were compared to 379 controls who had paroxysmal AFib and who underwent pulmonary vein isolation during the same period. According to the study results, 39 patients in PsAF group 1 and 276 controls were free from atrial tachycardia. Arrhythmia-free rates in both groups were higher than in PsAF group 2 (58.4%; P=0.005).

“The sequential low-dose ibutilide test is a simple method for identifying patients with persistent AFib in whom pulmonary vein isolation alone is an appropriate treatment strategy,” the authors wrote.

The study was published in EP Europace.