Ablation of Mitral AFL after AF RFA

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Home > Professional Education > Self Study > Webcasts > Atrial Fibrillation > Ablation of Mitral AFL after AF RFA

Ablation of Mitral AFL after AF RFA

In this presentation, Gregory K. Feld, MD, FHRS reviews the EKG morphology of atypical LA flutter. An upright P wave in V1 may be useful for suggesting a LA flutter. The EKG, however, may be misleading when you look at flutter after AF ablation. The importance of achieving bidirectional block is empahsized. Dr. Feld reviews the anatomy of the mitral isthmus placing emphasis on its unique anatomic features. Examples of atypical atrial flutter were demonstrated, both with electrophysiologic techniques and with electroanatomic mapping. With mitral isthmus flutters, typical entrainment may be demonstrated either endocardially or epicardially. In a large percentage of these patients, the ablation must be completed from the coronary sinus using an irrigated catheter or a large tip catheter. Mitral isthmus flutter may also be seen with a septal circuit, between the right inferior pulmonary vein and the mitral isthmus. The septal circuit is near the lower part of the limbus of the foramen ovale. In patients with linear ablation, if there is not bidirectional block after ablation, it is more likely to have recurrent atrial flutter.

Date Released: April 2, 2010

Term of Approval: April 2, 2013

Target Audience

This program is intended for a professional audience.

Cardiac electrophysiologists
Cardiology and cardiac electrophysiology fellows
Cardiac surgeons
Other cardiologists and radiologists

Learning Objectives

Upon completion of this educational activity, participants will be able to:

Identify clinical circumstances where the mitral isthmus should be ablated
Restate the background of circumferential ablation for atrial fibrillation
Recap how linear ablation allows for the potential of reentrant circuits around the mitral annulus
Recall the electrophysiologic testing of MV isthmus ablation
Characterize complications and risks of mitral isthmus ablation

Faculty

Gregory K. Feld, MD, FHRS
University of California San Diego Medical Center
San Diego, CA

Author

Kenneth A. Ellenbogen, MD, FHRS
Virginia Commonwealth University Medical Center
Richmond, VA

Disclosures (PDF, 10KB)

Accreditation

The Heart Rhythm Society is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Continuing Medical Education (CME)

The Heart Rhythm Society designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credits^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

The AMA has determined that physicians not licensed in the USA who participate in this CME activity are eligible for AMA PRA Category 1 Credits^TM.

Continuing Education (CE) for Nurses

The Heart Rhythm Society is an approved provider of continuing nursing education by the New York State Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

It has been assigned code 7M7R3X-PRV-09-04.

A maximum of 1.0 credit hours are available for this educational activity.

View Webcast

Ablation of Mitral AFL after AF RFA

Required Hardware and Software

Computer Screen with USB Drive Screen resolution of 1024x786 or larger
Sound card and speakers/headphones
Operating System Requirement: Windows Vista; Windows XP Service Pack 2, Windows 7 Intel® Pentium® III 450MHz or faster processor (or equivalent) 128MB or RAM Mac OS Apple Mac OS X 10.4.8 or above Intel Core TM Duo 1.83GHz or faster processor 128MB of RAM Plug-in

Supported by an educational grant from: