Transoesophageal pacing with prolonged bursts (30 s) after oral propafenone interrupted new onset atrial flutter in 85% of patients, compared to 20% with short bursts without treatment (P<0.05).
RCT (n=80)
Randomized into four groups
Does the combination of oral propafenone and prolonged bursts improve the interruption of new onset atrial flutter by transoesophageal pacing in patients with new onset atrial flutter?
The combination of oral propafenone and prolonged bursts (30 s) during transoesophageal pacing is the most effective protocol for terminating new onset atrial flutter.
Absolute Event Rate: 85% vs 20%
p-value: p=<0.05
AIM: We evaluated the effect of different stimulation protocols on atrial flutter interruption by transoesophageal pacing. METHODS AND RESULTS: Eighty patients with new onset atrial flutter were randomized into four groups. Pacing was attempted under the following conditions: with short bursts (5 s), without treatment (group A) and after oral administration of propafenone 600 mg (group B); with prolonged bursts (30 s), without treatment (group C) and after oral administration of propafenone 600 mg (group D). Pacing interrupted atrial flutter in 20% of patients in A, 55% in B, 50% in C and 85% in D. The use of longer bursts gave better results both in patients without treatment (P < 0.05: C vs A) and in patients with propafenone (P < 0.05: D vs B). Comparing groups with the same stimulation protocol, we observed a better response in patients treated with propafenone (P < 0.05: B vs A and D vs C). In the groups without treatment the use of shorter bursts was associated with a lower induction of stable atrial fibrillation (three vs nine episodes), in the groups on propafenone no differences were observed (one vs one episode). CONCLUSIONS: We conclude that the association of propafenone with long bursts gives the best result for interruption of new onset atrial flutter by transoesophageal pacing.
Flavio Doni (Sun,) conducted a rct in New onset atrial flutter (n=80). Transoesophageal pacing with prolonged bursts (30 s) and oral propafenone vs. Short bursts (5 s) without treatment was evaluated on Interruption of atrial flutter (p=<0.05). Transoesophageal pacing with prolonged bursts (30 s) after oral propafenone interrupted new onset atrial flutter in 85% of patients, compared to 20% with short bursts without treatment (P<0.05).