Results from the Loire-Ardeche-Drome-Isere-Puy-de-Dome (LADIP) Trial on Atrial Flutter, a multicentric prospective randomized study comparing amiodarone and radiofrequency ablation after the first episode of symptomatic atrial flutter

被引:94
作者
Da Costa, Antoine
Thevenin, Jerome
Roche, Frederic
Romeyer-Bouchard, Cecile
Abdellaoui, Loucif
Messier, Marc
Denis, Lucien
Faure, Emmanuel
Gonthier, Regis
Kruszynski, Georges
Pages, J. Marie
Bonijoly, Serge
Lamaison, Dominique
Defaye, Pascal
Barthelemy, J. Claude
Gouttard, Thierry
Isaaz, Karl
机构
[1] Univ St Etienne, Dept Physiol, Div Cardiol, St Etienne, France
[2] Firminy Hosp, Div Cardiol, Firminy, France
[3] Bakken Res Ctr, Maastricht, Netherlands
[4] St Chamond Hosp, Div Cardiol, St Chamond, France
[5] Valence Hosp, Div Cardiol, Valence, France
[6] La Charite Hosp, Dept Med Eldery, St Etienne, France
[7] Feurs Hosp, Div Cardiol, Feurs, France
[8] Montbrison Hosp, Div Cardiol, Montbrison, France
[9] Annonay Hosp, Div Cardiol, Annonay, France
[10] Univ Clermont Ferrand 2, Div Cardiol, Clermont Ferrand, France
[11] Univ Grenoble, Hop Nord, Div Cardiol, Grenoble, France
关键词
ablation; arrhythmia; atrial flutter; catheter ablation;
D O I
10.1161/CIRCULATIONAHA.106.638395
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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-Ardeche-Drome-Isere-Puy-de-Dome (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.
引用
收藏
页码:1676 / 1681
页数:6
相关论文
共 38 条
[1]   Radiofrequency catheter ablation of common atrial flutter - Significance of palpitations and quality-of-life evaluation in patients with proven isthmus block [J].
Anselme, F ;
Saoudi, N ;
Poty, H ;
Douillet, R ;
Cribier, A .
CIRCULATION, 1999, 99 (04) :534-540
[2]   Catheter ablation of typical atrial flutter -: A randomized comparison of 2 methods for determining complete bidirectional isthmus block [J].
Anselme, F ;
Savouré, A ;
Cribier, A ;
Saoudi, N .
CIRCULATION, 2001, 103 (10) :1434-1439
[3]   LONG-TERM ORAL PROPAFENONE THERAPY FOR SUPPRESSION OF REFRACTORY SYMPTOMATIC ATRIAL-FIBRILLATION AND ATRIAL-FLUTTER [J].
ANTMAN, EM ;
BEAMER, AD ;
CANTILLON, C ;
MCGOWAN, N ;
GOLDMAN, L ;
FRIEDMAN, PL .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1988, 12 (04) :1005-1011
[4]   MANAGEMENT OF ATRIAL-FLUTTER AFTER THE FONTAN PROCEDURE [J].
BALAJI, S ;
JOHNSON, TB ;
SADE, RM ;
CASE, CL ;
GILLETTE, PC .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1994, 23 (05) :1209-1215
[5]   ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias -: Executive summary a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop guidelines for the management of patients with supraventricular arrhythmias) [J].
Blomström-Lundqvist, C ;
Scheinman, MM ;
Aliot, EM ;
Alpert, JS ;
Calkins, H ;
Camm, AJ ;
Campbell, WB ;
Haines, DE ;
Kuck, KH ;
Lerman, BB ;
Miller, DD ;
Shaeffer, CW ;
Stevenson, WG ;
Tomaselli, GF ;
Antman, EM ;
Smith, SC ;
Alpert, JS ;
Faxon, DP ;
Fuster, V ;
Gibbons, RJ ;
Gregoratos, G ;
Hiratzka, LF ;
Hunt, SA ;
Jacobs, AK ;
Russell, RO ;
Priori, SG ;
Blanc, JJ ;
Budaj, A ;
Burgos, EF ;
Cowie, M ;
Deckers, JW ;
Garcia, MAA ;
Klein, WW ;
Lekakis, J ;
Lindahl, B ;
Mazzotta, G ;
Morais, JCA ;
Oto, A ;
Smiseth, O ;
Trappe, HJ .
CIRCULATION, 2003, 108 (15) :1871-1909
[6]  
Bru P, 2000, PACE, V23, P1908
[7]   Results of catheter ablation of typical atrial flutter [J].
Calkins, H ;
Canby, R ;
Weiss, R ;
Taylor, G ;
Wells, P ;
Chinitz, L ;
Milstein, S ;
Compton, S ;
Oleson, K ;
Sherfesee, L ;
Onufer, J .
AMERICAN JOURNAL OF CARDIOLOGY, 2004, 94 (04) :437-442
[8]   Pharmacologic therapy of atrial flutter [J].
Campbell, RWF .
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, 1996, 7 (10) :1008-1012
[9]   Electrophysiological effects of catheter ablation of inferior vena cava-tricuspid annulus isthmus in common atrial flutter [J].
Cauchemez, B ;
Haissaguerre, M ;
Fischer, B ;
Thomas, O ;
Clementy, J ;
Coumel, P .
CIRCULATION, 1996, 93 (02) :284-294
[10]   Cavotricuspid isthmus mapping to assess bidirectional block during common atrial flutter radiofrequency ablation [J].
Chen, J ;
de Chillou, C ;
Basiouny, T ;
Sadoul, N ;
Da Silva, J ;
Magnin-Poull, I ;
Messier, M ;
Aliot, E .
CIRCULATION, 1999, 100 (25) :2507-2513