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.
- DCCV, direct current cardioversion
- INR, International Normalised Ratio
- QOL, quality of life
- TV–IVC, tricuspid valve–inferior vena cava isthmus
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Published Online First 28 November 2006
Funding: We are grateful to the British Heart Foundation for their support with funding.
Competing interests: None.