Conclusions
Peri-mitral flutter is increasingly common in the presence of more extensive atrial substrate ablation for AF. Accordingly, mitral isthmus ablation should not be considered a first-line strategy for AF given the proarrhythmic nature of incomplete or non-transmural ablation lines. As newer tools and techniques such as VOM alcohol ablation and electroporation become more established, the role of empiric mitral isthmus ablation may evolve. Given the relative paucity of randomised evidence, mitral isthmus ablation should largely be reserved for patients with peri-mitral flutter.