title: Catheter ablation of atrial flutter after orthotopic heart transplantation.
abstract: BACKGROUND
  Atrial arrhythmias, including atrial flutter, are common in orthotopic heart transplant recipients. However, only a small number of individual case reports describe the electrical circuit and catheter ablation of atrial flutter after heart transplantation.
  
  
  RESULTS
  Detailed electrophysiologic evaluation and radiofrequency ablation of atrial flutter were performed in three patients after orthotopic heart transplantation. All cases involved a counterclockwise flutter circuit around the tricuspid annulus. All were successfully ablated at the isthmus between the tricuspid valve and the atrial anastomosis adjacent to the inferior vena cava.
  
  
  CONCLUSIONS
  Atrial flutter involving a counterclockwise circuit around the tricuspid annulus is common in the heart transplant population. Based on the patients described in this study and other cases reported in the literature, this arrhythmia often is treated successfully by ablation of the isthmus between the tricuspid valve and the atrial anastomosis near the inferior vena cava.
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
authors.forename: E Kevin
authors.initials: EK
authors.lastname: Heist
authors.forename: Shephal K
authors.initials: SK
authors.lastname: Doshi
authors.forename: Jagmeet P
authors.initials: JP
authors.lastname: Singh
authors.forename: Thomas
authors.initials: T
authors.lastname: Di Salvo
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Semigran
authors.forename: Vivek Y
authors.initials: VY
authors.lastname: Reddy
authors.forename: David
authors.initials: D
authors.lastname: Keane
authors.forename: Jeremy N
authors.initials: JN
authors.lastname: Ruskin
authors.forename: Moussa
authors.initials: M
authors.lastname: Mansour
mesh_terms: D000328:Adult; D001282:Atrial Flutter / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation; D004562:Electrocardiography; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome