Key result
First-line radiofrequency catheter ablation significantly reduced the recurrence of atrial flutter compared to cardioversion and amiodarone therapy (3.8% vs 29.5%, P<0.0001).
Why the study?
Does first-line radiofrequency catheter ablation reduce the recurrence of atrial flutter and subsequent atrial fibrillation compared to cardioversion and amiodarone therapy in patients with a first episode of symptomatic atrial flutter?
RCT (n=104)
Yes
Does first-line radiofrequency catheter ablation reduce the recurrence of atrial flutter and subsequent atrial fibrillation compared to cardioversion and amiodarone therapy in patients with a first episode of symptomatic atrial flutter?
Absolute Event Rate: 3.8% vs 29.5%
p-value: p=<0.0001
First-line radiofrequency ablation for a first episode of symptomatic atrial flutter provides a better long-term success rate and fewer secondary effects compared to amiodarone therapy, without increasing the risk of subsequent atrial fibrillation.
Supports first-line radiofrequency ablation for symptomatic atrial flutter; confirms superiority over cardioversion plus amiodarone in reducing recurrence.
BACKGROUND: There is no published randomized study comparing amiodarone therapy and radiofrequency catheter ablation (RFA) after only 1 episode of symptomatic atrial flutter (AFL). The aim of the Loire-Ardèche-Drôme-Isère-Puy-de-Dôme (LADIP) Trial of Atrial Flutter was 2-fold: (1) to prospectively compare first-line RFA (group I) versus cardioversion and amiodarone therapy (group II) after only 1 AFL episode; and (2) to determine the impact of both treatments on the long-term risk of subsequent atrial fibrillation (AF). METHODS AND RESULTS: From October 2002 to February 2006, 104 patients (aged 78+/-5 years; 20 women) with AFL were included, with 52 patients in group I and 52 patients in group II. The cumulative risk of AFL or AF was interpreted with the use of Kaplan-Meier curves and compared by the log-rank test. Clinical presentation, echocardiographic data, and follow-up were as follows: age (78.5+/-5 versus 78+/-5 years), history of AF (27% versus 21.6%); structural heart disease (58% versus 65%), left ventricular ejection fraction (56+/-14% versus 54.5+/-14%), left atrial size (43+/-7 versus 43+/-6 mm), mean follow-up (13+/-6 versus 13+/-6 months; P=NS), recurrence of AFL (3.8% versus 29.5%; P<0.0001), and occurrence of significant AF beyond 10 minutes (25% versus 18%; P=0.3). Five complications (10%) were noted in group II (sick sinus syndrome in 2, hyperthyroidism in 1, and hypothyroidism in 2) and none in group I (0%) (P=0.03). CONCLUSIONS: RFA should be considered a first-line therapy even after the first episode of symptomatic AFL. There is a better long-term success rate, the same risk of subsequent AF, and fewer secondary effects.
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Costa et al. (2006) conducted an RCT in Symptomatic atrial flutter (AFL) (n=104). Radiofrequency catheter ablation (RFA) vs. Cardioversion and amiodarone therapy was evaluated on Recurrence of atrial flutter (AFL) (p=<0.0001). First-line radiofrequency catheter ablation significantly reduced the recurrence of atrial flutter compared to cardioversion and amiodarone therapy (3.8% vs 29.5%, P<0.0001).
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