Document Detail

The modified anterior line: an alternative linear lesion in perimitral flutter.
MedLine Citation:
PMID:  20050958     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Ablation of left atrial flutter (LAF) is often limited by the need for technically demanding linear lesions. We evaluated the safety and efficacy of a new modified anterior line (MAL), connecting the anterior/anterolateral mitral annulus with the left superior pulmonary vein for ablation of perimitral flutter. METHODS AND RESULTS: MAL was performed in 65 patients (15 females, age 63.6 +/- 9.8 years) with perimitral flutter using 3D mapping systems (70.8% Carto, 29.2% NavX). Perimitral flutter was either the presenting arrhythmia (73.8%) or an intermediate organized rhythm during atrial fibrillation ablation. Follow-up included repetitive 7-day Holter with 93.8% of patients off antiarrhythmics. MAL was acutely effective in 63/65 patients (96.9%). Termination to sinus rhythm occurred in 36 of 65 patients (55.4%), and in 27 of 65 patients (41.5%) there was a change to another LAF type. Bidirectional block across the MAL was achieved in 56 of 65 patients (86.1%). After 6 months of follow-up, 20 of 41 patients (48.8%) had a LAF recurrence, with 6 patients undergoing a reablation. In all redo patients the MAL was still complete and LAF mechanism was different to the initially targeted. No major complication occurred during the ablation procedures or in the postablation period. CONCLUSION: The MAL is a safe and effective linear lesion for the treatment of perimitral LAF. Its value compared to more established linear lesions as the mitral isthmus line has to be evaluated in larger studies.
Stylianos Tzeis; Armin Luik; Clemens Jilek; Claus Schmitt; Heidi L Estner; Jinjin Wu; Tilko Reents; Stephanie Fichtner; Christof Kolb; Martin R Karch; Gabriele Hessling; Isabel Deisenhofer
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-12-28
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  21     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-06-29     Completed Date:  2010-10-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  665-70     Citation Subset:  IM    
Deutsches Herzzentrum München & 1. Medizinische Klinik, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany.
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MeSH Terms
Atrial Flutter / surgery*
Catheter Ablation / adverse effects,  instrumentation*,  methods*
Data Interpretation, Statistical
Feasibility Studies
Follow-Up Studies
Heart Function Tests
Middle Aged
Mitral Valve / surgery*
Pulmonary Veins / anatomy & histology,  physiology
Treatment Outcome

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