Atrial Fibrillation After Ablation of Atrial Flutter: Who Is at Risk?

Radiofrequency catheter ablation targeting the isthmus between the tricuspid anulus and the inferior vena cava is an established therapy for typical atrial flutter (AFL). It is successful in more than 90% of patients [1–7]. However, in the clinical setting, AFL and atrial fibrillation (AF) often coexist, and the follow-up of patients successfully treated with transisthmus ablation is complicated by the occurrence of AF in 10–47% of patients [2, 5, 8–15]. Indeed, although caused by different electrophysiological mechanisms, AFL and AF may share the same arrhythmogenic substrate [12, 16, 17]. Identifying patients at higher risk of post-ablation AF occurrence after ablation was a major issue until the introduction of transisthmus catheter ablation.