1 patient enrolled (consented) but screen failed. Study stopped as unable to enroll.

This is a prospective, multi-center, non-randomized, un-blinded, observational trial.

This prospective, multicenter observational study will examine the ability of ECGi mapping to

1. Effect of Ibutilide on the number and size of the driver domains
2. Effect of ablation of Ibutilide-organized driver domains
3. Effect of PV isolation on driver domains

The researchers hypothesize that this approach will lead to successful arrhythmia control .

Inclusion Criteria:

• ≥ 18 years of age.

• ° Symptomatic persistent AF refractory or intolerant to at least 1 class I or III antiarrhythmic medication Persistent AF - defined as Persistent: AF that is sustained > 7 days. Episodes of AF which are terminated by electrical or pharmacologic cardioversion after ≥ 48 hours of AF, but prior to 7 days, should also be classified as persistent AF episodes.

  • Planned to undergo first catheter ablation procedure ( prior atrial flutter typical is allowed)

• Ability to understand the requirements of the study and sign the informed consent form.

• Willingness to adhere to study restrictions and comply with all post-procedural follow-up requirements

• Projected lifespan greater than 1 year

Exclusion Criteria:

• They have baseline prolonged QT or renal failure precluding safe used of ibutilide
• Rheumatic heart disease,
• Current intra-cardiac thrombus,
• History of MI or CABG within 6 weeks;
• Class IV HF,
• Unable to sign consent
• Projected lifespan of < 1 year
• Women known to be pregnant or to have positive beta-HCG.
• Participation in another study that would interfere with this study.
• Unstable Angina
• Recent cerebral ischemic events
• Contraindication to anticoagulation
• Prior history of polymorphic ventricular tachycardia or torsades de pointes

1 year

Participant screen failed