Low-Dose Ibutilide Combined with Catheter Ablation of Persistent Atrial Fibrillation: Procedural Impact and Clinical Outcome

Figure 3

An example of persistent atrial fibrillation (AF) ablation with this low-dose ibutilide-guided approach. (a) The AF cycle length (AFCL) within the left atrial appendage (LAA) at baseline, after circumferential pulmonary vein isolation (CPVI), and 5 and 15 minutes after administration of 0.25 mg ibutilide. (b) Three electroanatomic maps showing the sites where low-amplitude complex fractionated atrial electrograms (CFAEs) were recorded on the anterior wall of the left atrium (LA). The pink, yellow, and white points represent CFAEs recorded before CPVI, after CPVI, and after administration of 0.25 mg ibutilide, respectively. The CFAE areas were minimized after CPVI plus ibutilide. (c) Ablation targeting these areas converted AF to atrial tachycardia (AT). (d) The 3D electroanatomic mapping of LA suggested that the mechanism of this AT was perimitral reentrant tachycardia (left upper), and ablation (alone) at the mitral isthmus terminated this AT.