Catheter ablation of atrial flutter and macroreentrant atrial tachycardia.

Catheter ablation has evolved from an experimental technique to first-line therapy for the treatment of atrial flutter. Atrial flutter is characterized by a macroreentrant atrial tachycardia circuit. Successful ablation of atrial flutter involves (1) mapping the atrial flutter to define the conduction zones within the re-entrant circuit to determine whether the atrial flutter is isthmus-dependent, non-isthmus-dependent, or atypical; (2) interrupting the atrial flutter macroreentrant circuit with an ablation catheter by creating either focal or linear lesions within a critical zone of slow conduction that extends to anatomical borders; and (3) terminating the tachycardia and demonstrating conduction block within the atrial flutter circuit after ablation. This update discusses the classification schemes of atrial flutter and macroreentrant atrial tachycardias, reviews the technique of radiofrequency catheter ablation, and highlights recent ablation approaches for atrial flutters and macroreentrant atrial tachycardias.