Document Detail

Peri-mitral atrial flutter in patients with atrial fibrillation ablation.
MedLine Citation:
PMID:  19962945     Owner:  NLM     Status:  In-Process    
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.
Seiichiro Matsuo; Matthew Wright; Sébastien Knecht; Isabelle Nault; Nicolas Lellouche; Kang-Teng Lim; Leonardo Arantes; Mark D O'Neill; Mélèze Hocini; Pierre Jaïs; Michel Haïssaguerre
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-10-06
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  7     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-02-04     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2-8     Citation Subset:  IM    
Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France.
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