Atrial flutter: radiofrequency ablation reduced hospitalisation and development of AF compared with medical therapy

Clinical bottom line (level 1b)

  1. Patients with at least 2 episodes of symptomatic atrial flutter who received radiofrequency ablation compared with medical therapy were less likely to be hospitalised (NN T = 2 at 21 months) , and were less likely to develop atrial fibrillation (NN T = 4 at 21 months) .
Natale et al: Journal of the American College of Cardiology 2000; 35 : 1898-1904
Expires October 2004

The study

Unblinded ?concealed randomised trial with intention-to-treat
Setting: 3 acute hospitals, USA and Italy

61 patients (aged ?, 69% male) with at least 2 episodes of symptomatic atrial flutter in the last 4 months

Excluded if
  • prior evidence of atrial fibrillation
  • significant atrial enlargement (4.5 cm or more)
  • previous treatment with antiarrhythmic medication

    Control Group: (n = 30, 30 analysed): drug therapy
    Experimental Group: (n = 31, 31 analysed): radiofrequency ablation

    100% followed for 21 months

    The evidence

    Outcome Time to outcome CER EER RRR
    (95% CI)    		 ARR
    (95% CI)    		 NN T
    (95% CI)
    rehospitalisation 21 months 19
    (63.3%)    		 7
    (22.6%)    		 64%
    (28% to 82%)    		 40.8%
    (18.1% to 63.4%)    		 2
    (2 to 6)
    developed atrial fibrillation 21 months 16
    (53.3%)    		 9
    (29.0%)    		 46%
    (-4% to 71%)    		 24.3%
    (0.34% to 48.3%)    		 4
    (2 to 290)

    Comments

    1. Patients who received radiofrequency ablation reported improvements in daily function and sense of well-being, whereas patients on drugs reported no change.

    Citation

    1. Natale A, Newby KH, Pisano E, et al: prospective randomized comparison of antiarrhythmic therapy versus first-line radiofrequency ablation in patients with atrial flutter. Journal of the American College of Cardiology 2000; 35 : 1898-1904
    Search Terms: from Other Articles Noted in ACP Journal Club
    Contributor: Chris Ball, October 2001
    Reviewer:

    Clinical Question.
    Patient symptomatic atrial flutter
    Intervention or Exposure radiofrequency ablation
    Comparison medical therapy
    Outcome hospitalisation, development of atrial fibrillation (AF)
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