title: The role of radiofrequency ablation as a first line therapy in the treatment of atrial flutter.
abstract: Cavo-tricuspid isthmus radiofrequency (RF) ablation is an efficient option in the treatment of atrial flutter. In the case of a well-tolerated, first episode of atrial flutter, it has a class II indication, level of evidence B, the current first-line therapeutic option being electrical cardioversion, pharmacological cardioversion or atrial overdrive pacing followed by long-term antiarrhythmic therapy. The purpose of this study was to evaluate, in a prospective manner, the recurrence rate of these two different therapeutic options after the treatment of a first episode of atrial flutter.
  
  
  METHODS
  Between January 2007 and May 2009, for 99 patients admitted to the hospital for a first episode of atrial flutter, cardioversion was attempted either by RF ablation (group 1-42 patients), or by electrical cardioversion, pharmacological cardioversion or atrial overdrive pacing followed by long-term Amiodarone therapy (group 21-57 patients). We compared the recurrence rate of atrial flutter in the 2 groups after a follow-up period of one year.
  
  
  RESULTS
  In group 1, sinus rhythm was achieved in all patients, with bidirectional isthmic block being obtained for 37 patients (88.1%). In group 2, conversion to sinus rhythm was obtained in all cases. The recurrence rate was 6 times higher in group 2 vs group 1 (57.9% = 33 patients vs 9.5% = 4 patients) (p = 0.01).
  
  
  CONCLUSIONS
  RF ablation should be considered as a therapeutic option in the treatment of the first episode of atrial flutter, due to its significant efficiency in maintaining sinus rhythm and to its low recurrence rate.
authors.affiliation: SCU Cluj-Napoca, Cardiology--Rehabilitation Hospital, Cluj-Napoca, Romania.
authors.forename: R
authors.initials: R
authors.lastname: Roşu
authors.forename: L
authors.initials: L
authors.lastname: Mureşan
authors.forename: M
authors.initials: M
authors.lastname: Andronache
authors.forename: Dana
authors.initials: D
authors.lastname: Pop
authors.forename: C
authors.initials: C
authors.lastname: Pop
authors.forename: Maria
authors.initials: M
authors.lastname: Puşchiţă
authors.forename: Adina
authors.initials: A
authors.lastname: Mălai
authors.forename: G
authors.initials: G
authors.lastname: Guşetu
authors.forename: D
authors.initials: D
authors.lastname: Zdrenghea
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001282:Atrial Flutter / Q000601:surgery*; D017115:Catheter Ablation; D003131:Combined Modality Therapy; D004554:Electric Countershock; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence
chemical_list: D000889:Anti-Arrhythmia Agents