The Necessity of Mitral Valve Isthmus Blockline for Peri-Mitral Atrial Flutter

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Peri-mitral atrial flutter (PMFL) is occasionally encountered in patients of ablation. We evaluated the necessity of mitral valve isthmus blockline for peri-mitral atrial flutter. From January 2009 to May 2011, seventeen consecutive patients (12 males, age 56±8.3) with PMFL were included in this study. Of the 17 parents, 12 patients had no other heart disease, 2 patients had angina pectoris (1 post PCI, 1 post CABG), 1 patient had a history of open heart surgery (MVP, TAP and Maze), 2 had the other heart disease. Previously 10 parents underwent ablation for pulmonary vein isolation (PVI), 7 parents had no history of PVI. On the seventeen parents with PMFL, 12 (70%, 12/17) parents were performed ablation for PMFL. The mitral valve isthmus blockline was achieved in 58% (7/12), and required ablation into coronary sinus (CS) was 71% (5/7). All patients achieve termination of tachycardia during the ablation. As us follow-up of 13±8.1 months, there were no recurrence of PMFL at all parents (17/17). We suggested that we can finish ablation for PMFL at the termination of tachycardia as the endpoint of ablation. And we considered ablation into CS when the tachycardia couldn’t terminated by only operating intra left-atrial ablation.