Heart 2007;93:688-693
CLINICAL TRIALS
Can atrial fibrillation with a coarse electrocardiographic appearance be treated with catheter ablation of the tricuspid valve–inferior vena cava isthmus? Results of a multicentre randomised controlled trial
1 St Bartholomew’s Hospital, London, UK
2 Derriford Hospital, Plymouth, UK
3 St Mary’s Hospital, London, UK
4 Aberdeen Royal Infirmary, Aberdeen, UK
Correspondence to:
Dr R Schilling
Cardiac Research Department, 1st Floor, Dominion House, 60 Bartholomew Close, St Bartholomew’s Hospital, West Smithfield, London EC1A 7BE, UK; r.schilling{at}qmul.ac.uk
Objective: To see if strategy of ablating the tricuspid annulus–inferior vena cava isthmus (TV–IVC) is superior to electrical cardioversion to prevent recurrences in patients with coarse atrial fibrillation.
Design: Prospective randomised controlled multicentre study.
Setting: Four tertiary referral hospitals in the UK.
Patients: 57 patients with persistent coarse atrial fibrillation (irregular P waves 
0.15 mV in 1 ECG lead).
Interventions: Patients were randomised to receive external cardioversion (group A, n = 30) or TV–IVC ablation +/– DC cardioversion (group B, n = 27).
Main outcome measures: Cardiac rhythm, scores on quality of life and symptom questionnaires were assessed at 4, 16 and 52 weeks after the procedure.
Results: 20 (67%) patients in group A and 19 (70%) patients in group B were in sinus rhythm immediately after their index procedure. At 4, 16 and 52 weeks, the number of patients in sinus rhythm were 5, 3 and 2 in group A and 3, 3 and 1 in group B (p = NS). The quality of life and symptom questionnaire scores were similar in the two groups at each period of follow-up, although they were significantly better for sinus rhythm than for atrial fibrillation at each follow-up visit.
Conclusions: As a first-line strategy, TV–IVC ablation offers no advantages over direct current cardioversion for the management of coarse atrial fibrillation.
Abbreviations: DCCV, direct current cardioversion; INR, International Normalised Ratio; QOL, quality of life; TV–IVC, tricuspid valve–inferior vena cava isthmus
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