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(Circulation. 2006;114:1676-1681.)
© 2006 American Heart Association, Inc.

Arrhythmia/Electrophysiology

Results From the Loire-Ardèche-Drôme-Isère-Puy-de-Dôme (LADIP) Trial on Atrial Flutter, a Multicentric Prospective Randomized Study Comparing Amiodarone and Radiofrequency Ablation After the First Episode of Symptomatic Atrial Flutter

Antoine Da Costa, MD, PhD; Jérôme Thévenin, MD; Frédéric Roche, MD, PhD; Cécile Romeyer-Bouchard, MD; Loucif Abdellaoui, MD; Marc Messier, PhD; Lucien Denis, MD; Emmanuel Faure, MD; Régis Gonthier, MD; Georges Kruszynski, MD; J. Marie Pages, MD; Serge Bonijoly, MD; Dominique Lamaison, MD; Pascal Defaye, MD; J. Claude Barthélemy, MD, PhD; Thierry Gouttard, MD; Karl Isaaz, MD, FESC, for the Loire-Ardèche-Drôme-Isère-Puy-de-Dôme (LADIP) Trial of Atrial Flutter Investigators

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-Etienne, France (R.G.); Division of Cardiology, Feurs Hospital, Feurs, France (G.K.); Division of Cardiology, Montbrison Hospital, Montbrison, France (J.M.P.); Division of Cardiology, Annonay Hospital, Annonay, France (S.B., T.G.); Division of Cardiology, University of Clermont-Ferrand, Clermont-Ferrand, France (D.L.); and Division of Cardiology, University of Grenoble, Hôpital Nord, Grenoble, France (P.D.).

Correspondence to Dr Antoine Da Costa, Service de Cardiologie, Hôpital Nord, Centre Hospitalier Universitaire de Saint-Etienne, 42 055 Saint-Etienne Cedex 2, France. E-mail dakosta{at}aol.com

Received May 6, 2006; revision received July 14, 2006; accepted July 21, 2006

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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