Cardiology Online












16th World Congress on Heart Disease

controversies meeting

 


 


Radiofrequency Catheter Ablation Should Be Considered a First-Line Therapy After the First Episode of Symptomatic Atrial Flutter

October 26, 2006

By Sahar Bedrood B.S. and Asher Kimchi M.D.

Saint-Etienne- 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 of Circulation.

In this 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.

Clinical 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).

The study 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.

Co-authors: 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

 

 


                 ©1998-2010 Cardiology Online, Inc. All rights reserved.
                 Cardiology Online is a registered trademark of Cardiology Online, Inc.
                 CardiologyOnline.com