Peri-mitral atrial flutter in patients with atrial fibrillation ablation

Demonstration of peri-mitral atrial flutter (PMFL). A: Electroanatomic mapping in the left oblique view showing macroreentrant atrial tachycardia circulating the mitral annulus in a clockwise direction. B: Entrainment mapping at two separate sites on the mitral annulus. Corrected postpacing interval (PPI) was equal to atrial tachycardia cycle length on the posterior left atrium (i) and +20 ms on the anterior wall (ii). Shown are recordings from surface ECG leads II and V₁; mapping catheter (MAP); and distal, middle, and proximal coronary sinus (CSd, CSm, CSp); C: PMFL was terminated during radiofrequency application on the mitral isthmus. ABL = ablation catheter; CL = cycle length.

Characteristics of peri-mitral atrial flutter (PMFL) in the present study. AF = atrial fibrillation; ATCL = atrial tachycardia cycle length.

Incidence of peri-mitral atrial flutter (PMFL). A: PMFL was frequently observed in patients with concurrently performed mitral isthmus (MI) ablation compared to those without. B: Recurrence of PMFL was associated with prior mitral isthmus ablation during the initial ablation procedure for atrial fibrillation.