Prospective randomized comparison of antiarrhythmic therapy versus first-line radiofrequency ablation in patients with atrial flutter
Open accessAbstract
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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Two randomized studies found catheter ablation superior to antiarrhythmic drugs for atrial flutter recurrence, quality of life, repeat hospitalization, and drug side effects.
“Two randomized studies have shown the superiority of catheter ablation over AAD in terms of AFL recurrence, quality of life, repeat hospitalization and AAD side effects.153,154”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [154]
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- Authors
- Natale, A., Newby, K. H., Pisanó, E., Leonelli, F., Fanelli, R., Potenza, D., Beheiry, S., & Tomassoni, G.
- Affiliations
- Cleveland Clinic (US)
- Corresponding author
- Natale, Andrea
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2000-06
- Volume
- 35
- Issue
- 7
- Pages
- 1898-1904
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2040907740
- Cited by
- 414
- References
- 27
- Citations by year
- 2026: 9 · 2025: 19 · 2024: 14 · 2023: 10 · 2022: 16 · 2021: 13 · 2020: 14 · 2019: 11 · 2018: 16 · 2017: 17 · 2016: 12 · 2015: 15 · 2014: 13 · 2013: 13 · 2012: 14
- FWCI
- 11.12
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- atrial flutter, radiofrequency catheter ablation, antiarrhythmic drugs, first-line therapy, atrial fibrillation, arrhythmia recurrence, hospital readmission, quality of life, sinus rhythm maintenance
- MeSH terms
- Aged, Anti-Arrhythmia Agents, Atrial Flutter, Female, Follow-Up Studies, Humans, Male, Prospective Studies, Quality of Life, Catheter Ablation
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