RT Journal Article SR Electronic T1 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 JF Heart JO Heart FD BMJ Publishing Group Ltd and British Cardiovascular Society SP 688 OP 693 DO 10.1136/hrt.2006.102061 VO 93 IS 6 A1 Gupta, Dhiraj A1 Earley, Mark J A1 Haywood, Guy A A1 Richmond, Laura A1 Fitzgerald, Melissa A1 Kojodjojo, Pipin A1 Sporton, Simon C A1 Peters, Nicholas S A1 Broadhurst, Paul A1 Schilling, Richard J YR 2007 UL http://heart.bmj.com/content/93/6/688.abstract AB 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.