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

Figure 4

Ablation of the site with the most rapid atrial fibrillation cycle length (AFCL) uncovered by low-dose ibutilide administration terminated persistent AF. The middle figure is the 3D electroanatomic map of the left atrium (LA) in this patient. The red points represent the lesions surrounding the PV antrum. After administration of 0.25 mg ibutilide, the LA activity became organized, and the AFCL could be measured at most of the sites in the LA. From top to bottom on the right panel are the intracardiac recordings (abl) from the LA roof, septum, and bottom. The activity at these sites and in the LA appendage (left upper) was longer than that in the coronary sinus. However, the AFCL at the posterolateral aspect of the LA (left middle, yellow point) was significantly shorter than that in the CS (194 vs 245 ms), suggesting that this area was harboring an AF driver. During regional ablation of this small region, AF converted to atrial tachycardia (AT, green point).