Volume 7, Issue 1, Pages 2-8 (January 2010)

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Volume 7, Issue 1, Pages 2-8 (January 2010) Peri-mitral atrial flutter in patients with atrial fibrillation ablation Seiichiro Matsuo, MD, Matthew Wright, MBBS, PhD, Sébastien Knecht, MD, Isabelle Nault, MD, Nicolas Lellouche, MD, Kang-Teng Lim, MD, Leonardo Arantes, MD, Mark D. O'Neill, MB, BCh, DPhil, Mélèze Hocini, MD, Pierre Jaïs, MD, Michel Haïssaguerre, MD Heart Rhythm Volume 7, Issue 1, Pages 2-8 (January 2010) DOI: 10.1016/j.hrthm.2009.09.067 Copyright © 2010 Heart Rhythm Society Terms and Conditions

Figure 1 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. Heart Rhythm 2010 7, 2-8DOI: (10.1016/j.hrthm.2009.09.067) Copyright © 2010 Heart Rhythm Society Terms and Conditions

Figure 2 Characteristics of peri-mitral atrial flutter (PMFL) in the present study. AF = atrial fibrillation; ATCL = atrial tachycardia cycle length. Heart Rhythm 2010 7, 2-8DOI: (10.1016/j.hrthm.2009.09.067) Copyright © 2010 Heart Rhythm Society Terms and Conditions

Figure 3 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. Heart Rhythm 2010 7, 2-8DOI: (10.1016/j.hrthm.2009.09.067) Copyright © 2010 Heart Rhythm Society Terms and Conditions