Abstract
OBJECTIVE: This study investigated efficacy of intraoperative ibutilide administration for cardioversion of persistent atrial fibrillation (AF) during catheter ablation and evaluated predictive factors for postoperative AF recurrence. METHODS: A retrospective analysis was conducted involving 111 patients with persistent AF who underwent radiofrequency catheter ablation. Patients who failed to restore sinus rhythm after ablation received intravenous ibutilide (1-2 mg). Patients achieving sinus rhythm post-ibutilide administration were categorized as responders, while non-responders underwent electrical cardioversion. Clinical data were collected, and logistic regression was utilized to identify factors associated with ibutilide response and postoperative AF recurrence. RESULTS: Sinus rhythm was restored by ibutilide in 73 patients (65.7%). Non-response to ibutilide was independently associated with longer AF duration (OR = 1.82), diabetes ellitus (OR = 2.27), coronary artery disease (OR = 2.56), increased ST2 (OR = 1.08), larger left atrial diameter (LAD) (OR = 1.25), elevated NT-proBNP (OR = 1.01), and higher CHA2DS2-VASc scores (OR = 1.96; all P < 0.05). AF recurrence within 3 months post-ablation was independently predicted by intraoperative ibutilide non-response (OR = 5.317), older age (OR = 1.213), diabetes mellitus (OR = 0.14), increased LAD (OR = 1.211), elevated ST2 (OR = 1.139), elevated hs-CRP (OR = 1.276), and higher CHA(2)DS(2)-VASc scores (OR = 2.736; all P < 0.05). CONCLUSION: Intraoperative ibutilide responsiveness significantly predicts postoperative AF recurrence in patients undergoing catheter ablation for persistent AF. Assessing ibutilide response may enhance risk stratification and guide personalized treatment strategies.