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

After years of development, radiofrequency ablation of common flutter circuits is a well established procedure. Once the structure of the circuit, and its critical isthmus, were defined, effective approaches to ablation have been developed, improving initial results. The problem of recurrence has been largely controlled, and the present recurrence rate is 10-15%. The large majority of recurrences can be treated successfully by a new ablation, with a very low incidence of second recurrence. Nevertheless, isthmus ablation is not a curative procedure, because it does not address the cause of flutter, only a necessary link in the circuit. The electrophysiologic and/or anatomic abnormalities of the atrium or atria persist after ablation. Perhaps for this reason there is an incidence of atrial fibrillation in 25-30% of cases after successful flutter ablation. On the other hand, some clinical data suggest that a first episode of flutter has a low incidence of recurrence after cardioversion. For all these reasons flutter ablation should not be considered as first line treatment in all episodes of atrial flutter, but of those with recurrences and/or poor tolerance.