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Treatments for atrial flutter include cardioversion without antiarrhythmic drug (AAD) therapy, cardioversion plus AAD therapy, and radiofrequency catheter ablation (RFCA). Researchers in France conducted a randomized trial comparing first-line RFCA with a strategy based on amiodarone therapy and, as needed, electrical cardioversion. Subjects were 103 patients (age ≥70) with a first symptomatic episode of ECG-documented atrial flutter with right-isthmus involvement, confirmed by electrophysiology study. No subject had previously received AAD therapy, 61% had structural heart disease, 68% had hypertension, and 24% had histories of atrial fibrillation.
RFCA achieved acute success in all 52 patients in the RFCA group. In the amiodarone group, al…