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  • Title: Transthoracic epicardial ablation of mitral isthmus for treatment of recurrent perimitral flutter.
    Author: Berruezo A, Bisbal F, Fernández-Armenta J, Calvo N, Cabrera JÁ, Sanchez-Quintana D, Andreu D, de Caralt TM, Brugada J, Mont L.
    Journal: Heart Rhythm; 2014 Jan; 11(1):26-33. PubMed ID: 24135498.
    Abstract:
    BACKGROUND: Perimitral flutter (PMF) is a common form of left atrial tachycardia after atrial fibrillation (AF) ablation. The mitral isthmus (MI) is the standard ablation target. However, in some cases bidirectional block cannot be achieved. OBJECTIVE: The purpose of this study was to describe the first experience using a transthoracic epicardial (TTE) approach to treat recurrent PMF after prior unsuccessful ablation. METHODS: This is a case series of four patients with recurrence of highly symptomatic drug-refractory PMF (all male, median age 55 years, 3/4 hypertensive, 2/4 persistent AF, median AF period 24 months). Three patients presented with PMF-related tachymyocardiopathy. TTE ablation of MI was performed after a median of two prior endocardial MI and coronary sinus ablation attempts, using an open-tip 3.5-mm irrigated catheter (40 W, 45ºC). Persistent bidirectional block was assessed by activation mapping and differential pacing and was achieved in all patients. RESULTS: No PMF recurrence was observed after median follow-up of 18 months (range 15-22 months; two patients without antiarrhythmic drugs and two with previously ineffective amiodarone). Left ventricular function normalized in all three patients with tachycardiomyopathy. There were no complications related to TTE approach. CONCLUSION: The present study is the first to report the feasibility of a TTE approach for highly symptomatic PMF refractory to endocardial and coronary sinus MI ablation.
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