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.