October 26, 2006|
Bedrood B.S. and Asher Kimchi M.D.
Until now, there have been no studies comparing amiodarone
therapy and radiofrequency catheter ablation (RFA) for patients
who have had one episode of atrial flutter (AFL). Antoine Da
Costa, MD, PhD et al from the University Jean Monnet in
Saint-Etienne, France did a study comparing the efficacy and
safety of first-line RFA versus AFL therapy. The study found
that RFA should be considered a first-line therapy even after
the first episode of symptomatic AFL due to better long-term
success rate, the same risk of subsequent AF and fewer secondary
effects. The study was published in the October 17, 2006 issue
study, 104 patients with AFL were divided into two groups
containing 52 patients each. Patients in group I received first
line treatment with RFA while patients in group II were treated
with cardioversion and amiodarone therapy. The impact of both
treatments on the long-term risk of subsequent atrial
fibrillation was determined.
presentation, echocardiographic data, and follow-up were as
follows: age (78.5 +/- 5 for the RFA group versus 78 +/- 5 years
for the amiodarone group), history of AF (27% for the RFA group
versus 21.6% for the amiodarone group), structural heart disease
(58% for the RFA group versus 65% for the amiodarone group),
left ventricular ejection fraction (54+/- 14% for the RFA group
versus 54.5 +/- 14% for the amiodarone group), left atrial size
(43 +/- 7 for the RFA group versus 43 +/- 6 mm for the
amiodarone group), recurrence of AFL (3.8% for the RFA group
versus 29.5% for the amiodarone group; 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).
concluded 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 side effects.
Antoine Da Costa, MD, PhD; Jérôme Thévenin, MD; Frédéric Roche,
MD, PhD; Cécile Romeyer-Bouchard, MD; Loucif Abdellaoui, MD;
Marc Messier, PhD; Lucien Denis, MD; Emmanuel Faure, MD; Régis
Gonthier, MD; Georges Kruszynski, MD; J. Marie Pages, MD; Serge
Bonijoly, MD; Dominique Lamaison, MD; Pascal Defaye, MD; J.
Claude Barthélemy, MD, PhD; Thierry Gouttard, MD; Karl Isaaz,
MD, FESC, for the Loire-Ardèche-Drôme-Isère-Puy-de-Dôme (LADIP)
Trial of Atrial Flutter Investigators