![]() ![]() ![]() 11 sought to help us better understand how to identify and localize the critical isthmus in left AFL and introduced a stepwise approach. 9,10 Fast and accurate identification and understanding of the re-entrant pathway and the critical conduction zone are crucial for the development and performance of a successful ablation strategy. 7,8 For non-isthmus-dependent right or left atrial macroreentrant tachycardia (so-called atypical AFL), the precise identification of the critical isthmuses for successful catheter ablation procedures is certainly more complex as multiple re-entrant pathways in the right and/or left atrium may be involved. 7 Catheter ablation for typical right atrial isthmus-dependent AFL has yielded a high success rate of 90-98% and a low recurrence rate of only 2-15% however, successful ablation depends on the correct identification of the reentrant circuit responsible for the arrythmia and its critical isthmus. 7 Catheter ablation is a promising treatment method to maintain sinus rhythm, especially in the case of cavotricuspid isthmus-dependent AFLs. 4–6 Due to the low success rate of pharmacological antiarrhythmic approaches in AFL, long-term drug therapy is less acceptable nowadays, and is recommended when ablation is not feasible. 3 So far, different therapeutic strategies have been introduced for AFL, including rate control, cardioversion to sinus rhythm (principally electrical cardioversion or high-rate stimulation), and catheter ablation. 2 Appropriate management of AFL is not only important due the symptoms, but also to the increased risk of complications, such as thromboembolism and stroke, which may lead to permanent disability or death. Approaches to the management and use of anticoagulation therapy are considered equivalent for AFL and AF and the same stroke prevention strategies are therefore recommended. 1 Moreover, a sizable proportion of patients who undergo AF ablation will develop AFL (atrial macroreentrant tachycardia is a more accurate term) as a secondary arrhythmia after the ablation procedure. A significant number of patients with AFL will develop atrial fibrillation (AF) afterwards. Atrial flutter (AFL) is one of the most common supraventricular arrhythmias in clinical practice. ![]()
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