Abstract:
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.
journal_name
Circulationjournal_title
Circulationauthors
Da Costa A,Thévenin J,Roche F,Romeyer-Bouchard C,Abdellaoui L,Messier M,Denis L,Faure E,Gonthier R,Kruszynski G,Pages JM,Bonijoly S,Lamaison D,Defaye P,Barthélemy JC,Gouttard T,Isaaz K,Loire-Ardèche-Drôme-Isère-Puy-de-Ddoi
10.1161/CIRCULATIONAHA.106.638395subject
Has Abstractpub_date
2006-10-17 00:00:00pages
1676-81issue
16eissn
0009-7322issn
1524-4539pii
CIRCULATIONAHA.106.638395journal_volume
114pub_type
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