[Radiofrequency ablation as the first line of treatment in patients with common atrial flutter. The arguments pro]

Radiofrequency ablation of atrial flutter may be performed nowadays with 90% probability of success, 10% of recurrences and a very low risk of complications; thus the indications of the procedure have lately expanded. However, there are still many discrepancies among different groups in the way to approach the acute and the chronic therapy for atrial flutter. Acute as well as chronic antiarrhythmic therapy has a limited effectivity and carries a risk of proarrythmia and extracardiac secondary effects. On the other hand, the potential risk of embolism during chronic therapy and after cardioversion is often underestimated. Another important issue often neglected is the tachycardiomyopathy secondary to the sustained high rate at the atrium and also at the ventricular level. The delay in the definitive therapy worsens the atrial remodelling and may promote the development of atrial fibrillation. We consider that radiofrequency ablation of atrial flutter is the first therapeutic option, and it should be attempted when the patient is seen, without further delay. In that way, the above mentioned potential risks are avoided, and for this reason, this is our common approach to therapy.