title: Catheter ablation by low energy DC shocks for successful management of atrial flutter.
abstract: OBJECTIVE
  To assess the effects of low energy ablation of the substrate for atrial flutter.
  
  
  METHODS
  Initial retrospective analysis of patients undergoing low energy ablation of the atrioventricular node for refractory atrial flutter (group 1) was followed by a prospective assessment of low energy ablation in the posterio-inferior right atrium for the same condition (group 2).
  
  
  METHODS
  Tertiary referral centre for management of cardiac arrhythmias.
  
  
  METHODS
  Seven men (aged 50-67 years) with refractory atrial flutter.
  
  
  METHODS
  Multiple (3-10) low energy DC shocks with a cumulative energy of 100-245 J in the region of the atrioventricular node in group 1 and 12-15 low energy DC shocks (cumulative energy 110-235 J) guided by the anatomical landmarks of the triangle of Koch and applied directly to the atrial wall.
  
  
  METHODS
  Freedom from recurrence of atrial flutter.
  
  
  RESULTS
  In group 1 despite initial complete atrioventricular block in three patients, atrioventricular conduction had resumed in all by one month. All four, however, were in sinus rhythm at follow up six to 13 months later. Two of the three patients in group 2 were free of atrial flutter at follow up three to four months after ablation.
  
  
  CONCLUSIONS
  Ablation of the atrial flutter substrate with low energy DC shocks is feasible. Precise electrophysiological mapping is not necessary.
authors.affiliation: Department of Cardiological Sciences, St George's Hospital Medical School, London.
authors.forename: S
authors.initials: S
authors.lastname: O'Núnáin
authors.forename: N J
authors.initials: NJ
authors.lastname: Linker
authors.forename: J F
authors.initials: JF
authors.lastname: Sneddon
authors.forename: N M
authors.initials: NM
authors.lastname: Debbas
authors.forename: A J
authors.initials: AJ
authors.lastname: Camm
authors.forename: D E
authors.initials: DE
authors.lastname: Ward
mesh_terms: D000368:Aged; D001282:Atrial Flutter / Q000601:surgery*; D001283:Atrioventricular Node / Q000601:surgery; D002036:Bundle of His / Q000601:surgery; D004564:Electrocoagulation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies