Ablation Strategies For Left Atrial Flutter

Focal atrial tachycardia and macroreentrant left atrial (LA) flutter are proarrhythmic complications of atrial fibrillation ablation, occurring with varying incidence from 2% to 30%. We describe an organized approach to the diagnosis and treatment of these troublesome arrhythmias. Practical management options for treating these arrhythmias are discussed, including conservative therapy, pharmacologic options, and repeat ablative therapy. Diagnostic approaches to localizing focal tachycardias and macroreentrant flutters using the surface electrocardiogram and electrophysiological maneuvers such as entrainment and electroanatomic activation mapping are discussed. Approaches to ablation of focal and macroreentrant tachycardias are described. Data on prognosis and complications are also presented. Recommendations are given to avoid developing this proarrhythmic complication following the initial atrial fibrillation ablation procedure.