{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:50:28Z","timestamp":1753876228287,"version":"3.41.2"},"reference-count":5,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2023,12,18]],"date-time":"2023-12-18T00:00:00Z","timestamp":1702857600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,12,21]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The radiofrequency catheter ablation of peri-mitral atrial flutter is occasionally difficult, mostly due to epicardial or intramural conduction on the mitral isthmus (MI). However, cryoballoon ablation (CBA) of peri-mitral atrial flutter refractory to radiofrequency ablation has not been reported.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>We report a case of a 66-year-old male patient who experienced a recurrence of atypical atrial flutter and underwent the sixth catheter ablation. The activation and entrainment maps showed that this atypical atrial flutter (AFL) was peri-mitral AFL via pathways other than endocardial conduction in the MI. Previous radiofrequency catheter ablation attempts on the MI line, including endocardial, coronary sinus, and epicardial ablations, failed to achieve a bidirectional block of the MI. In this case, we selected CBA for the MI area and successfully achieved a bidirectional block of the MI.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Although using CBA in the MI is off-label, it could be safely implemented using CARTOUNIVU\u2122. We attributed the success of the bidirectional block of the MI in this case to the crimping of the northern hemisphere of the CBA to the mitral isthmus area, which resulted in the formation of a broad, uniform, and deep ablation lesion site.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytad598","type":"journal-article","created":{"date-parts":[[2023,12,16]],"date-time":"2023-12-16T10:04:46Z","timestamp":1702721086000},"source":"Crossref","is-referenced-by-count":0,"title":["Cryoballoon ablation of peri-mitral atrial flutter refractory to radiofrequency ablation: a case report"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9440-289X","authenticated-orcid":false,"given":"Masao","family":"Takahashi","sequence":"first","affiliation":[{"name":"Department of Cardiology, Tokyo Metropolitan Hiroo Hospital , 2-34-10 Ebisu Shibuya-ku , Tokyo 150-0013, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5011-9654","authenticated-orcid":false,"given":"Hirofumi","family":"Kujiraoka","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tokyo Metropolitan Hiroo Hospital , 2-34-10 Ebisu Shibuya-ku , Tokyo 150-0013, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9564-3655","authenticated-orcid":false,"given":"Tomoyuki","family":"Arai","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tokyo Metropolitan Hiroo Hospital , 2-34-10 Ebisu Shibuya-ku , Tokyo 150-0013, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6332-2355","authenticated-orcid":false,"given":"Rintaro","family":"Hojo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tokyo Metropolitan Hiroo Hospital , 2-34-10 Ebisu Shibuya-ku , Tokyo 150-0013, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0291-9702","authenticated-orcid":false,"given":"Seiji","family":"Fukamizu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tokyo Metropolitan Hiroo Hospital , 2-34-10 Ebisu Shibuya-ku , Tokyo 150-0013, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,12,18]]},"reference":[{"key":"2024011805565623400_ytad598-B1","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.jacep.2015.08.011","article-title":"Peri-mitral atrial tachycardia using the marshall bundle epicardial connections","volume":"2","author":"Hayashi","year":"2016","journal-title":"JACC Clin Electrophysiol"},{"key":"2024011805565623400_ytad598-B2","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1016\/j.hrthm.2019.05.019","article-title":"The role of marshall bundle epicardial connections in atrial tachycardias after atrial fibrillation ablation","volume":"6","author":"Vlachos","year":"2019","journal-title":"Heart Rhythm"},{"key":"2024011805565623400_ytad598-B3","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1111\/jce.14379","article-title":"Clinical investigation of the durability of the lesions created by left atrial linear ablation with a cryoballoon","volume":"31","author":"Shigeta","year":"2020","journal-title":"J Cardiovasc Electrophysiol"},{"key":"2024011805565623400_ytad598-B4","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1007\/s10840-006-9052-2","article-title":"Variation in left atrial transmural wall thickness at sites commonly targeted for ablation of atrial fibrillation","volume":"17","author":"Hall","year":"2006","journal-title":"J Interv Card Electrophysiol"},{"key":"2024011805565623400_ytad598-B5","doi-asserted-by":"crossref","first-page":"2274","DOI":"10.1111\/jce.14150","article-title":"Relationship between time-to-isolation and freeze duration: computational modeling of dosing for arctic front advance and arctic front advance pro cryoballoons","volume":"30","author":"Getman","year":"2019","journal-title":"J Cardiovasc Electrophysiol"}],"container-title":["European Heart Journal - 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