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Peri-mitral atrial flutter in patients with atrial fibrillation ablation
Seiichiro Matsuo1, Matthew Wright, Sébastien Knecht
1Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France. mattsuu@tc4.so-net.ne.jp.
Background:
Peri-mitral atrial flutter (PMFL) is commonly encountered in patients undergoing atrial fibrillation (AF) ablation.
Objective:
The purpose of this study was to determine the electrophysiologic characteristics, procedural success, and medium-term outcomes in patients with PMFL.
Methods:
The study consisted of 50 consecutive patients (45 men and 5 women, age 57 +/- 12 years) with PMFL following or during AF ablation. Of the 50 PMFLs, 24 occurred during AF ablation (16 at index ablation and 8 at repeat procedure for recurrent AF), and 26 developed during follow-up. Ablation of PMFL was performed by creating a linear lesion joining the mitral annulus to the left inferior pulmonary vein.
Results:
The incidence of PMFL was higher in patients with mitral isthmus (MI) ablation performed during AF ablation, prior to the development of PMFL, than in those in whom MI ablation was not performed (23% vs 8%, P = .04). Following the procedure, PMFL was more frequent in patients with prior MI ablation than in those without (41% vs 15%, P <.01). Seventy percent (35/50) were terminated by ablation with 6.4 +/- 6.9 minutes of radiofrequency application. Among patients in whom PMFL terminated, supplemental ablation was required for bidirectional conduction block in 66% (23/35). MI block was achieved in 92% (46/50) using 13.6 +/- 7.4 minutes of ablation. At mean follow-up of 19 +/- 4 months, 96% of patients were free from PMFL.
Conclusion:
PMFL can be terminated by MI ablation, but the procedure is proarrhythmic. Supplemental ablation is necessary to establish bidirectional block of the line despite termination of PMFL in the majority of patients.
Insights
Peri-mitral atrial flutter (PMFL) ablation successfully terminates the arrhythmia in most patients. However, supplemental ablation is crucial to ensure complete block and prevent recurrence, as the initial procedure can be proarrhythmic.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Ablation
Background:
- Peri-mitral atrial flutter (PMFL) is a common complication in patients undergoing atrial fibrillation (AF) ablation.
- Understanding PMFL's characteristics is crucial for managing patients post-AF ablation.
Purpose of the Study:
- To determine the electrophysiologic characteristics of PMFL.
- To assess procedural success and medium-term outcomes of PMFL ablation.
Main Methods:
- Study included 50 consecutive patients with PMFL post-AF ablation.
- PMFL ablation involved creating a linear lesion from the mitral annulus to the left inferior pulmonary vein.
- Mitral isthmus (MI) ablation was assessed for its role in PMFL incidence and management.
Main Results:
- PMFL incidence was higher in patients with prior MI ablation.
- Seventy percent of PMFLs were terminated by ablation, requiring supplemental procedures for bidirectional block in 66%.
- Mitral isthmus block was achieved in 92% of patients, with 96% remaining free from PMFL at 19-month follow-up.
Conclusions:
- Mitral isthmus ablation can terminate PMFL but carries a risk of being proarrhythmic.
- Supplemental ablation is necessary to achieve bidirectional block and ensure long-term success.
- PMFL ablation is effective for achieving freedom from arrhythmia in the medium term.
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