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Our study aims to present clinical and electrophysiological data of presumed \u201clone AFL\u201d in pediatric patients and discuss the role of endomyocardial biopsy (EMB) and further follow-up. Since July 2005, eight consecutive patients at a median age of 12.7 (range 10.4\u201316.7) years presenting with presumed \u201clone AFL\u201d after negative non-invasive diagnostic work-up had electrophysiological study (EPS) and induction of cavotricuspid isthmus (CTI) conduction block by radiofrequency (RF) current application. In 6\/8 patients EMB could be taken. Induction of CTI conduction block was achieved in all patients. Histopathological examination of EMB from the right ventricular septum exhibited myocarditis or cardiomyopathy in 4\/6 patients, respectively. During follow-up, 4\/8 patients had recurrent arrhythmia (AFL <jats:italic>n<\/jats:italic>\u2009=\u20092, wide QRS complex tachycardia <jats:italic>n<\/jats:italic>\u2009=\u20091, monomorphic premature ventricular contractions <jats:italic>n<\/jats:italic>\u2009=\u20091) after the ablation procedure. 3\/4 patients with recurrent arrhythmia had pathological EMB results. The remaining patient with recurrent arrhythmia had a negative EMB but was diagnosed with Brugada syndrome during further follow-up. Taking together results of EMB and further clinical course, only 3\/8 patients finally turned out to have true \u201clone AFL\u201d. Our study demonstrates that true \u201clone AFL\u201d in children and adolescents is rare. EMB and clinical course revealed an underlying cardiac pathology in the majority of the individuals studied. EMB was very helpful in order to timely establish the diagnosis of myocarditis or cardiomyopathy.<\/jats:p>","DOI":"10.1007\/s00246-020-02491-z","type":"journal-article","created":{"date-parts":[[2020,11,9]],"date-time":"2020-11-09T13:05:36Z","timestamp":1604927136000},"page":"361-369","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Lone Atrial Flutter in Children and Adolescents: Is It Really \u201cLone\u201d?"],"prefix":"10.1007","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8443-919X","authenticated-orcid":false,"given":"Jana-K.","family":"Dieks","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7478-5005","authenticated-orcid":false,"given":"David","family":"Backhoff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5946-4342","authenticated-orcid":false,"given":"Heike E.","family":"Schneider","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias J.","family":"M\u00fcller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich","family":"Krause","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Paul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,11,9]]},"reference":[{"key":"2491_CR1","doi-asserted-by":"publisher","first-page":"1337","DOI":"10.1093\/europace\/eut082","volume":"15","author":"J Brugada","year":"2013","unstructured":"Brugada J, Blom N, Sarquella-Brugada G, Blomstrom-Lundqvist C, Deanfield J, Janousek J, Abrams D, Bauersfeld U, Brugada R, Drago F, de Groot N, Happonen JM, Hebe J, Yen Ho S, Marijon E, Paul T, Pfammatter JP, Rosenthal E, A European Heart Rhythm Association for European P, Congenital C (2013) Pharmacological and non-pharmacological therapy for arrhythmias in the pediatric population: EHRA and AEPC-Arrhythmia Working Group joint consensus statement. 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