title: Feasibility of catheter ablation of mitral annular flutter in patients with prior mitral valve surgery.
abstract: BACKGROUND
  Mitral annular flutter (MAF) may occur after ablation of atrial fibrillation in patients with prior mitral valve (MV) replacement or repair. Percutaneous catheter ablation may be challenging owing to the presence of surgical scar and a prosthetic MV.
  
  
  OBJECTIVE
  We examined the feasibility of and outcome after mitral isthmus ablation in patients with prior MV surgery.
  
  
  METHODS
  Twenty-one consecutive patients (18 males, age 61 ± 10 years) with a history of MV surgery (nine replacement, 12 repair with annuloplasty ring) underwent catheter ablation of clinical (n = 17) or easily inducible (n = 4) MAF (group 1). Patients were matched for age, gender, and ejection fraction, with 21 patients undergoing MAF ablation without prior MV surgery (group 2). Irrigated ablation was delivered endocardially in a linear fashion from the MV to the left inferior and/or to the right superior pulmonary vein and, when required, epicardially inside the coronary sinus. Isolation of all pulmonary veins was also performed.
  
  
  RESULTS
  There was no difference in termination of tachycardia during ablation (group 1 vs. group 2; 86% vs. 71%; P = .454), achieving mitral isthmus block (71% vs. 71%; P = 1.000), or need for epicardial ablation (43% vs. 62%; P = .354) between groups. No complications occurred in either group. After a mean follow-up of 7 ± 4 months, 15 (71%) patients in group 1 and 14 (67%) in group 2 had no recurrence of atrial arrhythmias.
  
  
  CONCLUSIONS
  Percutaneous mitral isthmus ablation is feasible and safe in patients with prior MV replacement or repair and has comparable outcomes to patients without prior MV surgery.
authors.affiliation: Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Stavros
authors.initials: S
authors.lastname: Mountantonakis
authors.forename: David S
authors.initials: DS
authors.lastname: Frankel
authors.forename: Mathew D
authors.initials: MD
authors.lastname: Hutchinson
authors.forename: Sanjay
authors.initials: S
authors.lastname: Dixit
authors.forename: Michael
authors.initials: M
authors.lastname: Riley
authors.forename: David J
authors.initials: DJ
authors.lastname: Callans
authors.forename: Fermin
authors.initials: F
authors.lastname: Garcia
authors.forename: David
authors.initials: D
authors.lastname: Lin
authors.forename: Wendy
authors.initials: W
authors.lastname: Tzou
authors.forename: Rupa
authors.initials: R
authors.lastname: Bala
authors.forename: Francis E
authors.initials: FE
authors.lastname: Marchlinski
authors.forename: Edward P
authors.initials: EP
authors.lastname: Gerstenfeld
mesh_terms: D001282:Atrial Flutter / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome