title: Can atrial fibrillation with a coarse electrocardiographic appearance be treated with catheter ablation of the tricuspid valve-inferior vena cava isthmus? Results of a multicentre randomised controlled trial.
abstract: OBJECTIVE
  To see if strategy of ablating the tricuspid annulus-inferior vena cava isthmus (TV-IVC) is superior to electrical cardioversion to prevent recurrences in patients with coarse atrial fibrillation.
  
  
  METHODS
  Prospective randomised controlled multicentre study.
  
  
  METHODS
  Four tertiary referral hospitals in the UK.
  
  
  METHODS
  57 patients with persistent coarse atrial fibrillation (irregular P waves > or =0.15 mV in > or =1 ECG lead).
  
  
  METHODS
  Patients were randomised to receive external cardioversion (group A, n = 30) or TV-IVC ablation +/- DC cardioversion (group B, n = 27).
  
  
  METHODS
  Cardiac rhythm, scores on quality of life and symptom questionnaires were assessed at 4, 16 and 52 weeks after the procedure.
  
  
  RESULTS
  20 (67%) patients in group A and 19 (70%) patients in group B were in sinus rhythm immediately after their index procedure. At 4, 16 and 52 weeks, the number of patients in sinus rhythm were 5, 3 and 2 in group A and 3, 3 and 1 in group B (p = NS). The quality of life and symptom questionnaire scores were similar in the two groups at each period of follow-up, although they were significantly better for sinus rhythm than for atrial fibrillation at each follow-up visit.
  
  
  CONCLUSIONS
  As a first-line strategy, TV-IVC ablation offers no advantages over direct current cardioversion for the management of coarse atrial fibrillation.
authors.affiliation: St Bartholomew's Hospital, West Smithfield, London, UK.
authors.forename: Dhiraj
authors.initials: D
authors.lastname: Gupta
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Earley
authors.forename: Guy A
authors.initials: GA
authors.lastname: Haywood
authors.forename: Laura
authors.initials: L
authors.lastname: Richmond
authors.forename: Melissa
authors.initials: M
authors.lastname: Fitzgerald
authors.forename: Pipin
authors.initials: P
authors.lastname: Kojodjojo
authors.forename: Simon C
authors.initials: SC
authors.lastname: Sporton
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Peters
authors.forename: Paul
authors.initials: P
authors.lastname: Broadhurst
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Schilling
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D017115:Catheter Ablation; D004554:Electric Countershock; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D055502:Secondary Prevention; D011795:Surveys and Questionnaires; D014261:Tricuspid Valve / Q000601:surgery*; D014682:Vena Cava, Inferior / Q000601:surgery*