Efficacy of ablation at the anteroseptal line for the treatment of perimitral flutter

Bernard Abi-Saleh; Hadi Skouri; Daniel J Cantillon; Jeffery Fowler; Oussama Wazni; Patrick Tchou; Walid Saliba

doi:10.1016/j.joa.2015.06.001

Efficacy of ablation at the anteroseptal line for the treatment of perimitral flutter

J Arrhythm. 2015 Dec;31(6):359-63. doi: 10.1016/j.joa.2015.06.001. Epub 2015 Jul 7.

Authors

Bernard Abi-Saleh¹, Hadi Skouri¹, Daniel J Cantillon², Jeffery Fowler², Oussama Wazni², Patrick Tchou², Walid Saliba²

Affiliations

¹ Department of Internal Medicine (Cardiology Division/Cardiac Electrophysiology Section), American University of Beirut Medical Center, P.O. Box 11-0236, Beirut, Lebanon.
² Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Section of Cardiac Electrophysiology and Pacing, Cleveland Clinic, Cleveland, OH, USA.

Abstract

Background: Left atrial flutter following atrial fibrillation (AF) ablation is increasingly common and difficult to treat. We evaluated the safety and efficacy of ablation of the anteroseptal line connecting the right superior pulmonary vein (RSPV) to the anteroseptal mitral annulus (MA) for the treatment of perimitral flutter (PMF).

Methods: We systematically studied patients who were previously treated with AF ablation and who presented to the electrophysiology laboratory with atrial tachyarrhythmias between January 2000 and July 2010. The diagnosis of PMF was confirmed by activation mapping and/or entrainment. After re-isolation of any recovered pulmonary vein, a linear radiofrequency (RF) ablation was performed on the line that connected the RSPV to the anteroseptal MA. In this analysis, we included only patients who were treated with an anteroseptal line for their PMF.

Results: Ablation was performed at the anteroseptal line in 27 PMF patients (63±13 years; 9 women) who had undergone prior ablation for paroxysmal (n=3) or persistent (n=24) AF, using electroanatomic activation mapping (70% CARTO, 30% NavX). The anteroseptal ablation line was effective in 22/27 (81.5%) patients in the acute-care setting. Termination of AF to sinus rhythm occurred in 15/22 (68.2%) patients, and 7/22 (31.8%) patients׳ AF converted to another right or left atrial flutter. At the 6-month follow-up, 20% of patients demonstrated recurrent left atrial tachyarrhythmia. Only one patient required repeat ablation, and the remaining patients׳ condition was controlled with antiarrhythmic medications. No major procedural complications or heart block occurred.

Conclusion: Ablation at the left atrial anteroseptal line is safe and efficacious for the treatment of PMF. Unlike ablation at the traditional mitral isthmus line, ablation at the left atrial anteroseptal line does not require ablation in the coronary sinus.

Keywords: AAD, Antiarrhythmic drug; AF, Atrial fibrillation; Ablation; Atrial fibrillation; CS, Coronary sinus; CTI, Cavotricuspid isthmus; ICE, Intracardiac echocardiography; LA, Left atrium; LAA, Left atrial appendage; Left atrial anteroseptal line; MA, Mitral annulus; PMF, Perimitral flutter; PVI, Pulmonary vein isolation; Perimitral flutter; RF, Radiofrequency; RSVP, Right superior pulmonary vein.