title: Ablation of perimitral flutter: acute and long-term success of the modified anterior line.
abstract: OBJECTIVE
  The modified anterior line (MAL) is an alternative to the mitral isthmus (MI) line for the treatment of perimitral atrial flutter (PMFL). We sought to investigate acute and long-term efficacy of this line if routinely used for PMFL.
  
  
  RESULTS
  The cohort included 77 consecutive patients who underwent catheter ablation of PMFL. The anterior line was deployed between the anterolateral mitral annulus and the ostium of the left superior pulmonary vein. Perimitral atrial flutter was either the presenting arrhythmia after persistent atrial fibrillation (AF) ablation (Group 1, n = 42, 54.5%), occurring during AF ablation (Group 2, n = 25, 35%) or presenting as primary arrhythmia (Group 3, n = 8, 10%). Acute success was defined as PMFL termination during MAL deployment with demonstration of bidirectional line block. Acute success was achieved in 68 of 77 patients (88%) without difference between the three groups. In five patients an additional MI line was necessary to terminate PMFL and in four patients both lines failed to achieve termination. During follow-up (16 ± 7 months), 38 of 77 (49%) patients underwent a repeat procedure for a recurrent arrhythmia. During reablation, 13 of 38 (34%) patients were identified to have a PMFL recurrence. Persistent MAL block was demonstrated in 22 of 38 (58%) patients during the repeat ablation.
  
  
  CONCLUSIONS
  The MAL is effective for acute and long-term treatment of PMFL. Maintenance of bidirectional MAL block was shown in 58% of patients during a repeat ablation.
authors.affiliation: Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, D-80636 Munich, Germany ammar@dhm.mhn.de.
authors.forename: Sonia
authors.initials: S
authors.lastname: Ammar
authors.affiliation: IV. Medizinische Klinik des Staedtischen Klinikums Karlsruhe, Germany.
authors.forename: Armin
authors.initials: A
authors.lastname: Luik
authors.affiliation: Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, D-80636 Munich, Germany.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Hessling
authors.affiliation: Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, D-80636 Munich, Germany.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Bruhm
authors.affiliation: Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, D-80636 Munich, Germany.
authors.forename: Tilko
authors.initials: T
authors.lastname: Reents
authors.affiliation: Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, D-80636 Munich, Germany.
authors.forename: Verena
authors.initials: V
authors.lastname: Semmler
authors.affiliation: Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, D-80636 Munich, Germany.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Buiatti
authors.affiliation: Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, D-80636 Munich, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Kathan
authors.affiliation: Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, D-80636 Munich, Germany.
authors.forename: Monika
authors.initials: M
authors.lastname: Hofmann
authors.affiliation: Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, D-80636 Munich, Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: Kolb
authors.affiliation: IV. Medizinische Klinik des Staedtischen Klinikums Karlsruhe, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Schmitt
authors.affiliation: Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, D-80636 Munich, Germany.
authors.forename: Isabel
authors.initials: I
authors.lastname: Deisenhofer
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery; D001282:Atrial Flutter / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D016896:Treatment Outcome
keywords: Ablation; Atypical flutter; Line; Modified anterior linie; Perimitral flutter