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
Open accessAbstract
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-Ardèche-Drôme-Isère-Puy-de-Dôme (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.
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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 [153]
The poor outcomes of rhythm-control strategies seen in atrial fibrillation may also apply to atrial flutter when antiarrhythmic drugs are used.
“but with the use of antiarrhythmic drugs, the poor results of rhythm control strategies in AF may also apply to AFL. 152,153”
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 [153]
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- Authors
- Da Costa, A., Thévenin, 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., Barthélemy, J. C., Gouttard, T., & Isaaz, K.
- Affiliations
- From the Division of Cardiology (A.D.C., J.T., C.R.-B., K.I.), Department of Physiology (F.R., J.C.B.), University Jean Monnet in Saint-Etienne, Saint-Etienne, France; Division of Cardiology, Firminy Hospital, Firminy, France (L.A.); Bakken Research Center, Maastricht, Netherlands (M.M.); Division of Cardiology, Saint-Chamond Hospital, Saint-Chamond, France (L.D.); Division of Cardiology, Valence Hospital, Valence, France (E.F.); Department of Medicine for the Elderly, La Charité Hospital, Saint...
- Université Jean Monnet (FR)
- Venue
- Circulation
- Published
- 2006-10-17
- Volume
- 114
- Issue
- 16
- Pages
- 1676-1681
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2065695293
- Cited by
- 140
- References
- 39
- Citations by year
- 2026: 2 · 2025: 13 · 2024: 5 · 2023: 6 · 2022: 3 · 2021: 8 · 2020: 6 · 2019: 8 · 2018: 3 · 2017: 2 · 2016: 7 · 2015: 11 · 2014: 5 · 2013: 7 · 2012: 10
- FWCI
- 7.11
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (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, amiodarone, cardioversion, atrial fibrillation recurrence, first-line therapy, treatment complications, sick sinus syndrome, hyperthyroidism, hypothyroidism, elderly patients, structural heart disease, left atrial size, left ventricular ejection fraction
- MeSH terms
- Aged, Aged, 80 and over, Amiodarone, Atrial Flutter, Female, Follow-Up Studies, France, Humans, Male, Prospective Studies, Treatment Outcome, Catheter Ablation
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