New onset atrial flutter termination by overdrive transoesophageal pacing:effects of different protocols of stimulation

Aim We evaluated the effect of different stimulation protocols on atrial fl utter interruption by transoesophageal pacing. Methods and Results Eighty patients with new onset atrial flutter were rand omized into four groups. Pacing was attempted under the following condition s: with short bursts (5 s): without treatment (group A) and after oral admi nistration of propafenone 600 mg (group B) with prolonged bursts (30 s), wi thout treatment (group C) and after oral administration of propafenone 600 mg (group D). Pacing interrupted atrial flutter in 20% of patients in A, 55 % in B, 50% in C and 85% in D. The use of longer bursts gave better results both in patients without treatment (P<0.05: C vs Al and in patients with p ropafenone (P<0.05: D vs B). Comparing groups with the same stimulation pro tocol, we observed a better response in patients treated with propafenone ( P<0.05: B vs A and D vs C). In the groups without treatment the use of shor ter bursts was associated with a lower induction of stable atrial fibrillat ion (three vs nine episodes), in the groups on propafenone no differences w ere observed tone vs one episode). Conclusions We conclude that the association of propafenone with long burst s gives the best result for interruption of new onset atrial flutter by tra nsoesophageal pacing. (Europace 2000; 2: 292-296) (C) 2000 The European Soc iety of Cardiology.