Surgical radiofrequency ablation of atrial flutter: which operation should we choose?

The treatment of atrial flutter (AFL) in patients without structural heart disease (SHD) by transcatheter radiofrequency ablation of the cavotricuspid isthmus (CTI) and bilateral pulmonary veins has achieved good results. We report three cases of typical AFL treated by surgical radiofrequency ablation. One patient, without SHD, successfully underwent CTI ablation and cardioversion. The other two patients, with SHD, underwent CTI ablation, partial right atrial ablation and pulmonary vein isolation, but a normal sinus rhythm was not achieved. Therefore, standard maze IV surgery may be the best choice in patients with AFL and SHD.