Trial: Results from the Loire-Ardeche-Drome-Isere-Puy-de-Dome (LAPID) trial on atrial flutter, a multicenter prospective randomized study comparing amiodarone and radiofrequency ablation after the first episode of symptomatic atrial flutter.
Authors: Da Costa A, Thevenin J, Roche F, Romeyer-Bouchard C, Abdellaoui L, Messier M, Denis L, Faure E, Gonthier R, Kruszynski G, Pages M, Bonijoly S, Lamaison D, Defaye P, Barthelemy C, Gouttard T, Isaaz K, for the Loire-Ardeche-Drome-Isere-Puy-de-Dome (LAPID) trial of atrial flutter investigators.
Reference: Circulation 2006;114:1676-1681
Purpose: To 1) prospectively compare safety and efficacy of first-line radiofrequency ablation versus electrical cardioversion and amiodarone therapy for typical atrial flutter and 2) to determine the long-term impact of each treatment on the risk of subsequent atrial fibrillation
Number of Patients: 104
Number of Centers: 11
Design: Multicenter, prospective, randomized
Authors Conclusion: Radiofrequency ablation should be considered first line therapy for symptomatic typical atrial flutter even after the first episode. Compared to amiodarone, radiofrequency ablation has a better long term success rate, fewer side effects and the same risk of subsequent atrial fibrillation.
Key words: atrial flutter, radiofrequency catheter ablation, amiodarone, atrial fibrillation
Comment: This study supports the safe and effective role of radiofrequency ablation very early in the course of typical atrial flutter in older subjects (all > 70 years). Amiodarone was not tolerated in 10% of patients. Atrial fibrillation occurrence remains problematic for either strategy.
Ongoing Related Studies:
1. Isthmus Ablation with Gold Electrode for Treatment of Atrial Flutter
2. Randomized Study of Radiofrequency vs. Cryo-Ablation for Typical Isthmus-Dependent Atrial Flutter
3. Maximum Targeted Ablation of Atrial Flutter
4. Prevention of Atrial Fibrillation With ARB After Catheter Ablation
5. Catheter Evaluation for Endocardial Ablation in Patients With Typical Atrial Flutter
Summary written by Mark Wood, MD
