Published Online
on October 9, 2006

A more recent version of this article appeared on October 17, 2006

This Article Full Text (PDF) CME: Take the course for this article: Circulation: October 17, 2006, Volume 114, Number 16 All Versions of this Article: 114/16/1676    most recent CIRCULATIONAHA.106.638395v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Da Costa, A. Search for Related Content PubMed PubMed Citation Articles by Da Costa, A. Related Collections Ablation/ICD/surgery Arrhythmias, clinical electrophysiology, drugs Related Article

Submitted on May 6, 2006
Revised on July 14, 2006
Accepted on July 21, 2006

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.).

^* To whom correspondence should be addressed. E-mail: dakosta{at}aol.com.

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.

Key words: ablation • arrhythmia • atrial flutter • catheter ablation

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