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Da Costa, A. et al.

Da Costa, Th??venin, Roche, Romeyer-Bouchard, Abdellaoui, Messier, Denis, Faure, Gonthier, Kruszynski, Pages, Bonijoly, Lamaison, Defaye, Barth??lemy, Gouttard, Isaaz,

Results from the Loire-Ard??che-Dr??me-Is??re-Puy-de-D??me (LADIP) Trial on atrial flutter, a multicentric prospective randomized study comparing amiodarone and radiofrequency ablation after the first episode of symptomatic atrial flutter.

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-Ard??che-Dr??me-Is??re-Puy-de-D??me (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.[1]

References

Results from the Loire-Ard??che-Dr??me-Is??re-Puy-de-D??me (LADIP) Trial on atrial flutter, a multicentric prospective randomized study comparing amiodarone and radiofrequency ablation after the first episode of symptomatic atrial flutter. Da Costa, A., Th??venin, J., Roche, F., Romeyer-Bouchard, C., Abdellaoui, L., Messier, M., Denis, L., Faure, E., Gonthier, R., Kruszynski, G., Pages, J.M., Bonijoly, S., Lamaison, D., Defaye, P., Barth??lemy, J.C., Gouttard, T., Isaaz, K. Circulation (2006) [Pubmed]

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