Mitral isthmus ablation is an established technique used to treat perimitral atrial flutter. The classic approach involves creating an ablation line connecting the left inferior pulmonary vein (LIPV) to the lateral mitral annulus.1 Its feasibility was first prospectively studied by Jais et al,1 who reported a high rate of bidirectional block. However, subsequent studies by the same group, as well as others, have been less promising.2 This is important because failure to achieve bidirectional block with ablation has been shown to be proarrhythmic.
Mitral isthmus ablation is an established technique used to treat perimitral atrial flutter. The classic approach involves creating an ablation line connecting the left inferior pulmonary vein (LIPV) to the lateral mitral annulus.1 Its feasibility was first prospectively studied by Jais et al,1 who reported a high rate of bidirectional block. However, subsequent studies by the same group, as well as others, have been less promising.2 This is important because failure to achieve bidirectional block with ablation has been shown to be proarrhythmic.