CLINICAL STUDIES
Prospective randomized comparison of antiarrhythmic therapy versus first-line radiofrequency ablation in patients with atrial flutter
Andrea Natale, MD*  ,
Keith H. Newby, MD* ,
Ennio Pisanó, MD* ,
Fabio Leonelli, MD* ,
Raffaele Fanelli, MD* ,
Domenico Potenza, MD* ,
Salwa Beheiry, RN* and
Gery Tomassoni, MD*
* Cleveland Clinic Foundation, Cleveland, Ohio; University of Kentucky, Lexington, Kentucky, USA
Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
Manuscript received April 27, 1999;
revised manuscript received December 16, 1999,
accepted February 14, 2000.
Reprint requests and correspondence: Dr. Andrea Natale, Director, Electrophysiology Laboratories, Section of Pacing and Electrophysiology, Department of Cardiology/F15, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195
natalea{at}ccf.org
BACKGROUND
Despite the high success rate of radiofrequency (RF) ablation, pharmacologic therapy is still considered the standard initial therapeutic approach for atrial flutter.
OBJECTIVE
We prospectively compared the outcome at follow-up of patients with atrial flutter randomly assigned to drug therapy or RF ablation.
METHODS
Patients with at least two episodes of symptomatic atrial flutter in the last four months were randomized to regimens of either antiarrhythmic drug therapy or first-line RF ablation. After institution of therapy, end points included recurrence of atrial flutter, rehospitalization and quality of life.
RESULTS
A total of 61 patients entered the study, 30 of whom were randomized to drug therapy and 31 to RF ablation. After a mean follow-up of 21 ± 11 months, 11 of 30 (36%) patients receiving drugs were in sinus rhythm, versus 25 of 31 (80%) patients who underwent RF ablation (p < 0.01). Of the patients receiving drugs, 63% required one or more rehospitalizations, whereas post-RF ablation, only 22% of patients were rehospitalized (p < 0.01). Following RF ablation, 29% of patients developed atrial fibrillation which was seen in 53% of patients receiving medications (p < 0.05). Sense of well being (pre-RF 2.0 ± 0.3 vs. post-RF 3.8 ± 0.5, p < 0.01) and function in daily life (pre-RF 2.3 ± 0.4 vs. post-RF 3.6 ± 0.6, p < 0.01) improved after ablation, but did not change significantly in patients treated with drugs.
CONCLUSION
In a selected group of patients with atrial flutter, RF ablation could be considered a first-line therapy due to the better success rate and impact on quality of life, the lower occurrence of atrial fibrillation and the lower need for rehospitalization at follow-up.
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Abbreviations and Acronyms
| | AF | = atrial fibrillation | | AV | = atrioventricular | | RF | = radiofrequency |
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