title: Peri-mitral atrial flutter in patients with atrial fibrillation ablation.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors: Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France. mattsuu@tc4.so-net.ne.jp.
authors: Seiichiro
authors: S
authors: Matsuo
authors: Matthew
authors: M
authors: Wright
authors: Sébastien
authors: S
authors: Knecht
authors: Isabelle
authors: I
authors: Nault
authors: Nicolas
authors: N
authors: Lellouche
authors: Kang-Teng
authors: KT
authors: Lim
authors: Leonardo
authors: L
authors: Arantes
authors: Mark D
authors: MD
authors: O'Neill
authors: Mélèze
authors: M
authors: Hocini
authors: Pierre
authors: P
authors: Jaïs
authors: Michel
authors: M
authors: Haïssaguerre
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery*; D001282:Atrial Flutter / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D017115:Catheter Ablation / Q000009:adverse effects*; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D011667:Pulmonary Veins; D012086:Reoperation; D012307:Risk Factors