Prospective randomized comparison of antiarrhythmic therapy versus first-line radiofrequency ablation in patients with atrial flutter

BACKGROUND Despite the high success rate of radiofrequency (RF) ablation, p harmacologic therapy is still considered the standard initial therapeutic a pproach for atrial flutter. OBJECTIVE We prospectively compared the outcome at follow-up of patients wi th atrial flutter randomly assigned to drug therapy or RF ablation. METHODS Patients with at least two episodes of symptomatic atrial flutter i n 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 randomize d to drug therapy and 31 to RF ablation. After a mean follow-up of 21 +/- 1 1 months, 11 of 30 (36%) patients receiving drugs were in sinus rhythm, ver sus 25 of 31 (80%) patients who underwent RF ablation (p < 0.01). Of the pa tients receiving drugs, 63% required one or more rehospitalizations, wherea s post-RF ablation, only 22% of patients were rehospitalized (p < 0.01). Fo llowing RF ablation, 29% of patients developed atrial fibrillation which wa s seen in 53% of patients receiving medications (p < 0.05). Sense of well b eing (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 Letter success rate an d impact on quality of life, the lower occurrence of atrial fibrillation an d the lower need for rehospitalization at follow-up. (J Am Coll Cardiol 200 0;35:1898-904) (C) 2000 by the American College of Cardiology.