Catheter Ablation as the First Line Therapy for Typical Atrial Flutter

Catheter Ablation as the First Line Therapy for Symptomatic Typical Atrial Flutter: A Multicenter Randomized Study of Cost/Effectiveness

Catheter ablation of typical atrial flutter is a well established technique with a high acute success rate and very low complication and recurrence rates. It has also been shown that ablation of recurrent symptomatic typical atrial flutter led to a clear improvement in quality of life. We sought to evaluate the cost/effectiveness of catheter ablation as the first line therapy in patient suffering from their first symptomatic typical atrial flutter episode. This study is a multicenter trial in which patients with a first symptomatic episode of typical atrial flutter are randomized to undergo ablation or to receive antiarrhythmic drugs after electrical cardioversion. Clinical examination, quality of life questionnaires,12 leads ECG and 24-hour Holter monitoring are performed at 1, 3, 6 and 12 months following randomization.The primary end-point is the absence of recurrence of typical atrial flutter at - and 12 months of follow up. The secondary end points are the cost and the cost/effectiveness ratio of these two approaches.

Inclusion Criteria:

• first episode of symptomatic typical atrial flutter
• > 18 years old

Exclusion Criteria:

• Prior antiarrhythmic drug treatment for atrial flutter
• History of cavotricuspid isthmus ablation
• Pregnancy
• Hyperthyroidism
• contraindication for anticoagulant therapy
• Life expectancy < 1 year
• contraindication to catheter ablation or to electrical cardioversion