title: 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.
abstract: 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).
  
  
  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.
authors.affiliation: Division of Cardiology, University Jean Monnet in Saint-Etienne, Saint-Etienne, France. dakosta@aol.com
authors.forename: Antoine
authors.initials: A
authors.lastname: Da Costa
authors.forename: Jérôme
authors.initials: J
authors.lastname: Thévenin
authors.forename: Frédéric
authors.initials: F
authors.lastname: Roche
authors.forename: Cécile
authors.initials: C
authors.lastname: Romeyer-Bouchard
authors.forename: Loucif
authors.initials: L
authors.lastname: Abdellaoui
authors.forename: Marc
authors.initials: M
authors.lastname: Messier
authors.forename: Lucien
authors.initials: L
authors.lastname: Denis
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Faure
authors.forename: Régis
authors.initials: R
authors.lastname: Gonthier
authors.forename: Georges
authors.initials: G
authors.lastname: Kruszynski
authors.forename: J Marie
authors.initials: JM
authors.lastname: Pages
authors.forename: Serge
authors.initials: S
authors.lastname: Bonijoly
authors.forename: Dominique
authors.initials: D
authors.lastname: Lamaison
authors.forename: Pascal
authors.initials: P
authors.lastname: Defaye
authors.forename: J Claude
authors.initials: JC
authors.lastname: Barthélemy
authors.forename: Thierry
authors.initials: T
authors.lastname: Gouttard
authors.forename: Karl
authors.initials: K
authors.lastname: Isaaz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000638:Amiodarone / Q000627:therapeutic use*; D001282:Atrial Flutter / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery*; D017115:Catheter Ablation; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000638:Amiodarone