Risk factors and Management of Mitral Annular Atrial Flutter After Mitral Valve Surgery

Purpose of Review: Macro-reentrant atrial tachycardias can occur in many patients after cardiac valve surgery. This review highlights the risk factors and special considerations for managing mitral annular flutter after mitral valve surgery. Recent Findings: Perimitral annular flutter wavefront usually rotates clockwise or counterclockwise, supported by endocardial structures and low-voltage, slow conduction areas. Recent studies have shown the benefits of a steerable sheath while manipulating it near the mitral valve and multipolar mapping catheter to confirm PV isolation, which is necessary to ensure enduring blocks across the mitral isthmus. Integration of the latest high-density mapping techniques with fluoroscopic images into diagnostic evaluation helps better delineate the flutter circuit and reduce the risk of radiation exposure and complications like catheter entrapment. Summary: In mitral valve surgery patients, mitral annular flutter is not uncommon. Hybrid thoracoscopic surgical techniques with subsequent percutaneous catheter-based ablation have been shown to reduce the cumulative risk of post-combined procedure risk of perimitral annular flutter. The details of surgical methods by the cardiothoracic surgical team might help better delineate the mechanisms of mitral annular flutter.