Author + information
- Received April 27, 1999
- Revision received December 16, 1999
- Accepted February 14, 2000
- Published online June 1, 2000.
- 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∗,‡
- ↵*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
Despite the high success rate of radiofrequency (RF) ablation, pharmacologic therapy is still considered the standard initial therapeutic approach for atrial flutter.
We prospectively compared the outcome at follow-up of patients with atrial flutter randomly assigned to drug therapy or RF ablation.
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.
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.
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.
☆ No industry support was provided for this study. Individual investigators have used financial support from institutional grants.
- Received April 27, 1999.
- Revision received December 16, 1999.
- Accepted February 14, 2000.
- American College of Cardiology