Atrial flutter: lessons from surgical interventions (musing on atrial flutter mechanism).

We report our experience with seven patients who underwent direct surgical ablation of problematic common flutter. Intraoperative mapping was obtained in four patients. Surgical techniques varied over time. A circular incision of the right atrium was performed in the first patient. Two patients had epicardial cryoablation of the isthmus between the inferior vena cava and the tricuspid valve annulus. Four patients had extensive endocardial cryoablation of the isthmus. There were no immediate postoperative complications. One patient had atrial fibrillation 2 months postoperatively and underwent a corridor operation 1 year later. The other six patients are free of arrhythmias without antiarrhythmic drugs. Surgical ablation confirmed that the common form of atrial flutter is associated with a right atrial macroreentrant circuit. One of our intraoperative endocardial maps suggested that variant reentrant circuits can be associated with variant forms of flutter.