Radiofrequency catheter ablation of atrial flutter: procedural success and long-term outcome

The objective of this study was to describe the procedural success and clinical recurrences after radiofrequency catheter ablation of atrial flutter. A deflectable catheter with a 4 or 5 mm tip was positioned in the posterior right atrium. Radiofrequency energy was delivered sequentially from the tricuspid annulus to the inferior vena cava. Catheter ablation during 18 sessions for 16 patients resulted in abrupt atrial flutter termination and noninducibility in all patients. Successful sites were near the os of the coronary sinus but had no distinguishing electrographic features. During a follow-up period of 8 +/- 5 months, 4 (25%) patients had recurrence of atrial flutter; 3 of 4 underwent successful repeat ablation. By actuarial analysis, 87% of patients remained in normal sinus rhythm 6 months after the initial procedure. The only distinguishing feature of those with recurrence compared with those whose sinus rhythm was maintained was the induction of nonclinical atrial arrhythmia (50% vs 0%, respectively; p < 0.05). One patient had resolution of presumed tachycardia-related cardiomyopathy. Catheter ablation by an anatomic approach was highly successful in terminating type 1 atrial flutter and was associated with good long-term response. This technique may represent a meaningful alternative for restoration and maintenance of normal sinus rhythm. However, further investigation is warranted to define its clinical role fully.