{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T09:31:54Z","timestamp":1770715914697,"version":"3.49.0"},"reference-count":71,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2022,6,9]],"date-time":"2022-06-09T00:00:00Z","timestamp":1654732800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Atypical atrial flutters (AAFL) are difficult-to-manage atrial arrhythmias, yet potentially amenable to effective radiofrequency catheter ablation (CA). However, data on CA feasibility are only sparingly reported in the literature in different clinical settings, such as AAFL related to surgical correction of congenital heart disease. The aim of this review was to provide an overview of the clinical settings in which AAFL may occur to help the cardiac electrophysiologist in the prediction of the tachycardia circuit location before CA. Moreover, the role and proper implementation of cutting-edge technologies in this setting were investigated as well as which procedural and clinical factors are associated with long-term failure to maintain sinus rhythm (SR) to find out which patients may, or may not, benefit from this procedure. Not only different surgical and non-surgical scenarios are associated with peculiar anatomical location of AAFL, but we also found that CA of AAFL is generally feasible. The success rate may be as low as 50% in surgically corrected congenital heart disease (CHD) patients but up to about 90% on average after pulmonary vein isolation (PVI) or in patients without structural heart disease. Over the years, the progressive implementation of three-dimensional mapping systems and high-density mapping tools has also proved helpful for ablation of these macro-reentrant circuits. However, the long-term maintenance of SR may still be suboptimal due to the progressive electroanatomic atrial remodeling occurring after cardiac surgery or other interventional procedures, thus limiting the likelihood of successful ablation in specific clinical settings.<\/jats:p>","DOI":"10.3390\/jcm11123323","type":"journal-article","created":{"date-parts":[[2022,6,10]],"date-time":"2022-06-10T02:25:33Z","timestamp":1654827933000},"page":"3323","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Procedural Feasibility and Long-Term Efficacy of Catheter Ablation of Atypical Atrial Flutters in a Wide Spectrum of Heart Diseases: An Updated Clinical Overview"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3278-1721","authenticated-orcid":false,"given":"Roberto","family":"De Ponti","sequence":"first","affiliation":[{"name":"Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy"},{"name":"Department of Heart and Vessels, Ospedale di Circolo, 21100 Varese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raffaella","family":"Marazzi","sequence":"additional","affiliation":[{"name":"Department of Heart and Vessels, Ospedale di Circolo, 21100 Varese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manola","family":"Vilotta","sequence":"additional","affiliation":[{"name":"Department of Heart and Vessels, Ospedale di Circolo, 21100 Varese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4925-7985","authenticated-orcid":false,"given":"Fabio","family":"Angeli","sequence":"additional","affiliation":[{"name":"Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, 21049 Tradate, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1205-5925","authenticated-orcid":false,"given":"Jacopo","family":"Marazzato","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy"},{"name":"Department of Heart and Vessels, Ospedale di Circolo, 21100 Varese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2356","DOI":"10.1093\/eurheartj\/ehv118","article-title":"Atrial flutter: More than just one of a kind","volume":"36","author":"Bun","year":"2015","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"141","DOI":"10.2174\/1573403X10666141013122231","article-title":"Atrial Macroreentry in Congenital Heart Disease","volume":"11","author":"Twomey","year":"2015","journal-title":"Curr. Cardiol. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1016\/j.hrthm.2016.12.002","article-title":"Postoperative atrial tachycardias after mitral valve surgery: Mechanisms and outcomes of catheter ablation","volume":"14","author":"Enriquez","year":"2017","journal-title":"Heart Rhythm"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1093\/europace\/eul077","article-title":"Left atrial tachycardia after circumferential pulmonary vein ablation for atrial fibrillation: Incidence, electrophysiological characteristics, and results of radiofrequency ablation","volume":"8","author":"Deisenhofer","year":"2006","journal-title":"Europace"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1111\/j.1540-8167.2007.00859.x","article-title":"Atrial macroreentry tachycardia in patients without obvious structural heart disease or previous cardiac surgical or catheter intervention: Characterization of arrhythmogenic substrates, reentry circuits, and results of catheter ablation","volume":"18","author":"Fiala","year":"2007","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1898","DOI":"10.1016\/S0735-1097(00)00635-5","article-title":"Prospective randomized comparison of antiarrhythmic therapy versus first- line radiofrequency ablation in patients with atrial flutter","volume":"35","author":"Natale","year":"2000","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1016\/j.jacep.2020.03.004","article-title":"Characterization of Complex Atrial Tachycardia in Patients with Previous Atrial Interventions Using High-Resolution Mapping","volume":"6","author":"Derval","year":"2020","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1007\/s10840-012-9705-2","article-title":"Surgical technique and the mechanism of atrial tachycardia late after open heart surgery","volume":"35","author":"Pap","year":"2012","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1800","DOI":"10.1093\/europace\/euu076","article-title":"Very long-term results of electroanatomic-guided radiofrequency ablation of atrial arrhythmias in patients with surgically corrected atrial septal defect","volume":"16","author":"Scaglione","year":"2014","journal-title":"Europace"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1161\/01.CIR.93.3.502","article-title":"Ablation of \u2018Incisional\u2019 Reentrant Atrial Tachycardia Complicating Surgery for Congenital Heart Disease","volume":"93","author":"Kalman","year":"1996","journal-title":"Circulation"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.1016\/j.hrthm.2005.07.009","article-title":"Mechanism and mapping of atrial arrhythmia in the modified Fontan circulation","volume":"2","author":"Abrams","year":"2005","journal-title":"Heart Rhythm"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1007\/s00246-017-1595-8","article-title":"Arrhythmias After Fontan Operation with Intra-atrial Lateral Tunnel Versus Extra-cardiac Conduit: A Systematic Review and Meta-analysis","volume":"8","author":"Li","year":"2017","journal-title":"Pediatr. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1973","DOI":"10.1016\/S0735-1097(02)01905-8","article-title":"Lesional tachycardias related to mitral valve surgery","volume":"39","author":"Markowitz","year":"2002","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2632","DOI":"10.1111\/jce.14666","article-title":"Catheter ablation of atrial tachycardias after mitral valve surgery: A systematic review and meta-analysis","volume":"31","author":"Marazzato","year":"2020","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"94","DOI":"10.23736\/S2724-5683.20.05405-5","article-title":"Ablation of atrial tachycardia in the setting of prior mitral valve surgery","volume":"69","author":"Marazzato","year":"2021","journal-title":"Minerva Cardiol. Angiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1007\/s10840-019-00509-y","article-title":"Catheter ablation for failed surgical maze: Comparison of cut and sew vs. non-cut and sew maze","volume":"55","author":"Winkle","year":"2019","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.1056\/NEJMoa1500528","article-title":"Surgical Ablation of Atrial Fibrillation during Mitral-Valve Surgery","volume":"372","author":"Gillinov","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"S29","DOI":"10.1016\/j.hrthm.2009.02.011","article-title":"Diagnosis and ablation of atypical atrial tachycardia and flutter complicating atrial fibrillation ablation","volume":"6","author":"Morady","year":"2009","journal-title":"Heart Rhythm"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1111\/jce.12423","article-title":"Comparison of Regular Atrial Tachycardia Incidence After Circumferential Radiofrequency versus Cryoballoon Pulmonary Vein Isolation in Real-Life Practice","volume":"25","author":"Bastani","year":"2014","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1093\/europace\/euu350","article-title":"Circumferential pulmonary vein isolation as index procedure for persistent atrial fibrillation: A comparison between radiofrequency catheter ablation and second-generation cryoballoon ablation","volume":"17","author":"Ciconte","year":"2015","journal-title":"Europace"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1660","DOI":"10.1016\/j.hrthm.2012.06.007","article-title":"Incidence, characteristics, and outcome of left atrial tachycardias after circumferential antral ablation of atrial fibrillation","volume":"9","author":"Wasmer","year":"2012","journal-title":"Heart Rhythm"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Leitz, P., Wasmer, K., Andresen, C., G\u00fcner, F., K\u00f6be, J., Rath, B., Reinke, F., Wolfes, J., Lange, P.S., and Ellermann, C. (2022). The Incidence, Electrophysiological Characteristics and Ablation Outcome of Left Atrial Tachycardias after Pulmonary Vein Isolation Using Three Different Ablation Technologies. J. Cardiovasc. Dev. Dis., 9.","DOI":"10.3390\/jcdd9020050"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2539","DOI":"10.1161\/hc4601.098517","article-title":"Atrial electroanatomic remodeling after circumferential radiofrequency pulmonary vein ablation: Efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation","volume":"104","author":"Pappone","year":"2001","journal-title":"Circulation"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.hrthm.2007.08.034","article-title":"Left atrial and pulmonary vein macroreentrant tachycardia associated with double conduction gaps: A novel type of man-made tachycardia after circumferential pulmonary vein isolation","volume":"5","author":"Satomi","year":"2008","journal-title":"Heart Rhythm"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1161\/01.CIR.0000141369.50476.D3","article-title":"Mechanisms of organized left atrial tachycardias occurring after pulmonary vein isolation","volume":"110","author":"Gerstenfeld","year":"2004","journal-title":"Circulation"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e004724","DOI":"10.1161\/CIRCEP.116.004724","article-title":"Visualizing Localized Reentry with Ultra-High Density Mapping in Iatrogenic Atrial Tachycardia","volume":"10","author":"Luther","year":"2017","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1016\/j.hrthm.2018.11.027","article-title":"Characterizing localized reentry with high-resolution mapping: Evidence for multiple slow conducting isthmuses within the circuit","volume":"16","author":"Frontera","year":"2019","journal-title":"Heart Rhythm"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e275","DOI":"10.1016\/j.hrthm.2017.05.012","article-title":"2017 HRS\/EHRA\/ECAS\/APHRS\/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation","volume":"14","author":"Calkins","year":"2017","journal-title":"Heart Rhythm"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1093\/europace\/euz301","article-title":"Intraprocedural endpoints to predict durable pulmonary vein isolation: A randomized trial of four post-ablation techniques","volume":"22","author":"Jiang","year":"2020","journal-title":"Europace"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1016\/S0735-1097(02)02036-3","article-title":"Noncontact three-dimensional mapping and ablation of upper loop re-entry originating in the right atrium","volume":"40","author":"Tai","year":"2002","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1016\/j.hrthm.2005.02.1038","article-title":"Scar-related right atrial macroreentrant tachycardia in patients without prior atrial surgery: Electroanatomic characterization and ablation outcome","volume":"2","author":"Stevenson","year":"2005","journal-title":"Heart Rhythm"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2440","DOI":"10.1161\/01.CIR.0000129439.03836.96","article-title":"Left septal atrial flutter: Electrophysiology, anatomy, and results of ablation","volume":"109","author":"Marrouche","year":"2004","journal-title":"Circulation"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1016\/j.jacep.2019.04.013","article-title":"Current Concepts of Anatomy, Electrophysiology, and Therapeutic Implications of the Interatrial Septum","volume":"5","author":"Kharbanda","year":"2019","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/S0735-1097(96)00154-4","article-title":"Catheter ablation of clinical intraatrial reentrant tachycardias resulting from previous atrial surgery: Localizing and transecting the critical isthmus","volume":"28","author":"Baker","year":"1996","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1032","DOI":"10.1016\/S0735-1097(97)00252-0","article-title":"Efficacy of Radiofrequency Ablation for Control of Intraatrial Reentrant Tachycardia in Patients with Congenital Heart Disease","volume":"30","author":"Triedman","year":"1997","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2928","DOI":"10.1161\/01.CIR.101.25.2928","article-title":"Mapping and ablation of left atrial flutters","volume":"101","author":"Shah","year":"2000","journal-title":"Circulation"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1665","DOI":"10.1016\/S0735-1097(01)01192-5","article-title":"Multi atrial maco-re-entry circuits in adults with repaired congenital heart disease: Entrainment mapping combined with three-dimensional electroanatomic mapping","volume":"37","author":"Delacretaz","year":"2001","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1161\/01.CIR.103.5.699","article-title":"Characterization of reentrant circuit in macroreentrant right atrial tachycardia after surgical repair of congenital heart disease: Isolated channels between scars allow \u201cfocal\u2033 ablation","volume":"103","author":"Nakagawa","year":"2001","journal-title":"Circulation"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1934","DOI":"10.1161\/01.CIR.0000015077.12680.2E","article-title":"Characterization of reentrant circuits in left atrial macroreentrant tachycardia: Critical isthmus block can prevent atrial tachycardia recurrence","volume":"105","author":"Ouyang","year":"2002","journal-title":"Circulation"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.1046\/j.1540-8167.2003.03292.x","article-title":"Delineation of intra-atrial reentrant tachycardia circuits after mustard operation for transposition of the great arteries using biatrial electroanatomic mapping and entrainment mapping","volume":"14","author":"Zrenner","year":"2003","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1016\/j.jacc.2004.05.057","article-title":"Non-contact mapping to guide radiofrequency ablation of atypical right atrial flutter","volume":"44","author":"Tai","year":"2004","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/j.hrthm.2004.04.020","article-title":"Irrigated-tip catheter ablation of intraatrial reentrant tachycardia in patients late after surgery of congenital heart disease","volume":"1","author":"Tanner","year":"2004","journal-title":"Heart Rhythm"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.hrthm.2004.10.034","article-title":"Ablation of atrial tachycardia after surgery for congenital and acquired heart disease using an electroanatomic mapping system: Which circuits to expect in which substrate?","volume":"2","author":"Lukac","year":"2005","journal-title":"Heart Rhythm"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1046\/j.1540-8167.2005.30605.x","article-title":"Mechanisms of Right Atrial Tachycardia Occurring Late After Surgical Closure of Atrial Septal Defects","volume":"16","author":"Miljoen","year":"2005","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1136\/hrt.2006.094748","article-title":"Dual-loop circuits in postoperative atrial macro re-entrant tachycardias","volume":"93","author":"Seiler","year":"2007","journal-title":"Heart"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1093\/europace\/eum055","article-title":"Treatment of macro-re-entrant atrial tachycardia based on electroanatomic mapping: Identification and ablation of the mid-diastolic isthmus","volume":"9","author":"Verlato","year":"2007","journal-title":"Europace"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1489","DOI":"10.1016\/j.hrthm.2007.07.027","article-title":"Radiofrequency ablation of atypical atrial flutter after cardiac surgery or atrial fibrillation ablation: A randomized comparison of open-irrigation-tip and 8-mm-tip catheters","volume":"4","author":"Bai","year":"2007","journal-title":"Heart Rhythm"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1781","DOI":"10.1016\/j.jacc.2007.07.044","article-title":"Atrial Tachycardia After Circumferential Pulmonary Vein Ablation of Atrial Fibrillation: Mechanistic Insights, Results of Catheter Ablation, and Risk Factors for Recurrence","volume":"50","author":"Chae","year":"2007","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/j.hrthm.2008.12.013","article-title":"Color-coded three-dimensional entrainment mapping for analysis and treatment of atrial macroreentrant tachycardia","volume":"6","author":"Esato","year":"2009","journal-title":"Heart Rhythm"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1016\/j.jacc.2010.04.061","article-title":"Outcome of Intra-Atrial Re-Entrant Tachycardia Catheter Ablation in Adults with Congenital Heart Disease: Negative Impact of Age and Complex Atrial Surgery","volume":"56","author":"Yap","year":"2010","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1111\/j.1540-8167.2009.01602.x","article-title":"Electroanatomic mapping and ablation of macroreentrant atrial tachycardia: Comparison between successfully and unsuccessfully treated cases","volume":"21","author":"Marazzi","year":"2010","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1093\/europace\/eur027","article-title":"Atrial tachycardias in patients with congenital heart disease: A minimally invasive simplified approach in the use of three-dimensional electroanatomic mapping","volume":"13","author":"Drago","year":"2011","journal-title":"Europace"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1111\/j.1540-8167.2012.02426.x","article-title":"Electroanatomic Characterization and Ablation Outcome of Nonlesion Related Left Atrial Macroreentrant Tachycardia in Patients without Obvious Structural Heart Disease","volume":"24","author":"Zhang","year":"2012","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"2048","DOI":"10.1016\/j.hrthm.2016.05.029","article-title":"Evaluation of a novel high-resolution mapping technology for ablation of recurrent scar-related atrial tachycardias","volume":"13","author":"Anter","year":"2016","journal-title":"Heart Rhythm"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.jacep.2018.10.011","article-title":"Catheter Ablation for Atrial Tachycardia in Adults with Congenital Heart Disease: Electrophysiological Predictors of Acute Procedural Success and Post-Procedure Atrial Tachycardia Recurrence","volume":"5","author":"Grubb","year":"2019","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1007\/s10840-021-00939-7","article-title":"High-density versus low-density mapping in ablation of atypical atrial flutter","volume":"62","author":"Balt","year":"2021","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1921","DOI":"10.1111\/jce.15034","article-title":"The isthmus characteristics of scar-related macroreentrant atrial tachycardia in patients with and without cardiac surgery","volume":"32","author":"Liu","year":"2021","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.1093\/europace\/euaa394","article-title":"Use of high-density activation and voltage mapping in combination with entrainment to delineate gap-related atrial tachycardias post atrial fibrillation ablation","volume":"23","author":"Vlachos","year":"2021","journal-title":"Europace"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1292","DOI":"10.1016\/j.jacep.2019.08.014","article-title":"Septal Versus Lateral Mitral Isthmus Ablation for Treatment of Mitral Annular Flutter","volume":"5","author":"Maheshwari","year":"2019","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1161\/CIRCEP.109.909838","article-title":"Long-term outcome after ablative therapy of postoperative atrial tachyarrhythmia in patients with congenital heart disease and characteristics of atrial tachyarrhythmia recurrences","volume":"3","author":"Atary","year":"2010","journal-title":"Circ. Arrhythmia Electrophysiol"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1111\/j.1540-8167.2000.tb00312.x","article-title":"Ablation of atypical atrial flutter guided by the use of concealed entrainment in patients without prior cardiac surgery","volume":"11","author":"Bogun","year":"2000","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1111\/jce.13867","article-title":"A novel octaray multielectrode catheter for high-resolution atrial mapping: Electrogram characterization and utility for mapping ablation gaps","volume":"30","author":"Sroubek","year":"2019","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Sarkozy, A., Vijgen, J., De Potter, T., Schilling, R., and Markides, V. (2022). An early multicenter experience of the novel high-density star-shaped mapping catheter in complex arrhythmias. J. Interv. Card. Electrophysiol., in press.","DOI":"10.1007\/s10840-022-01176-2"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1002\/joa3.12521","article-title":"A new interpretation of nonpulmonary vein substrates of the left atrium in patients with atrial fibrillation","volume":"37","author":"Rillo","year":"2021","journal-title":"J. Arrhythmia"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1016\/S0008-6363(02)00226-2","article-title":"Atrial structure and fibres: Morphologic bases of atrial conduction","volume":"54","author":"Ho","year":"2002","journal-title":"Cardiovasc. Res."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/j.hrthm.2020.11.008","article-title":"Epicardial course of the septopulmonary bundle: Anatomical considerations and clinical implications for roof line completion","volume":"18","author":"Pambrun","year":"2021","journal-title":"Heart Rhythm"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1007\/s11936-019-0752-1","article-title":"Impact of Technique and Technology on Mitral Isthmus Ablation","volume":"21","author":"Naniwadekar","year":"2019","journal-title":"Curr. Treat. Options Cardiovasc. Med."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1016\/j.hrthm.2018.10.005","article-title":"Mitral isthmus ablation: A hierarchical approach guided by electroanatomic correlation","volume":"16","author":"Pathik","year":"2019","journal-title":"Heart Rhythm"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1016\/j.hrthm.2012.03.008","article-title":"Ethanol infusion in the vein of Marshall facilitates mitral isthmus ablation","volume":"9","author":"Morales","year":"2012","journal-title":"Heart Rhythm"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1111\/j.1540-8167.2006.00568.x","article-title":"Fragmented, long-duration, low-amplitude electrograms characterize the origin of focal atrial tachycardia","volume":"17","author":"Schalij","year":"2006","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1007\/s10840-018-0359-6","article-title":"Focal intra-cavotricuspid isthmus atrial tachycardias occurring after typical atrial flutter ablation: Incidence and electrocardiographic and electrophysiological characteristics","volume":"52","author":"Itoh","year":"2018","journal-title":"J. Interv. Card. Electrophysiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/12\/3323\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:27:20Z","timestamp":1760138840000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/12\/3323"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,9]]},"references-count":71,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2022,6]]}},"alternative-id":["jcm11123323"],"URL":"https:\/\/doi.org\/10.3390\/jcm11123323","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,9]]}}}