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Catheter cryoablation of AVNRT is a clinically effective alternative to RF ablation, with excellent acute success rate. Despite a slightly higher rate of recurrence during long-term follow-up, these results suggest that cryoablation may be considered as first-line approach, especially in younger people, where the risk of permanent pacing because of inadvertent AV block may be relevant.

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Background: Following successful cavotricuspid isthmus (CTI) ablation during typical atrial flutter (AFL), anticoagulation therapy is usually withdrawn. However, potential subsequent atrial fibrillation (AF) in these patients may increase embolic risk in the long term. Embolic rates in this setting have not been clearly established. Our aim was to determine the incidence of stroke/systemic embolism following radiofrequency ablation of AFL, particularly in those without a prior history of AF. Hypothesis: After succesful AFL ablation, patients may suffer embolic complications in the long-term follow-up, mainly due to asymptomatic AF episodes. Methods: We conducted a retrospective analysis of all patients who underwent CTI ablation due to AFL in our center between 2006 and 2009. Results: During the study period, 188 patients (mean age, 62.9 ± 8.6 years) underwent CTI ablation; 120 without prior AF were included in the study. At the end of the follow-up period (mean, 5.0 ± 2.4 years), 56.7% of patients (68/120) remained in sinus rhythm, 7/120 experienced a recurrence of AFL, and 45/120 (38%) developed AF. Ischemic stroke occurred in 11 patients and systemic embolism in 1. Of these patients, 5 had documented AF following AFL ablation. In the remaining 7 cases, previously undiagnosed AF was subsequently diagnosed at the time of stroke/embolism. Conclusions: Patients with AFL who undergo successful ablation are by no means free from embolic complications during long-term follow-up, mainly due to a high rate of AF development. Given the difficulties in detecting AF and the uncertainty about the temporal relation of AF and stroke, oral anticoagulation may need to be continued in those patients with underlying stroke risk factors. IntroductionTypical atrial flutter (AFL) remains a common arrhythmia, closely related to atrial fibrillation (AF). 1 Until recently, however, clinical trials and observational studies grouped patients with both AFL and AF together, and the signs identifying flutter remained hidden, being much less frequent than AF. Although information on the prognostic significance and pharmacological treatment of AF and its systemic complications is abundant, data remain scarce regarding AFL; clinical recommendations are thus largely based on clinical observations and expert consensus rather than on evidence.The identification of the cavotricuspid isthmus (CTI) as a key arrhythmic substrate within the lower right atrium allows for successful catheter-based ablation therapy. In recent times, catheter ablation of the CTI has been increasingly used as first-line therapy, offering a high acute success rate coupled with a low complication rate in experienced electrophysiology laboratories.2 -4

Background Establishing a symptom–rhythm correlation in patients with unexplained syncope is complicated because of its sporadic, infrequent, and unpredictable nature. Prolonged monitoring with an implantable loop recorder (ILR) allows the recording of electrocardiogram (ECG) data from a spontaneous syncopal event. Hypothesis The aim of this study was to evaluate the usefulness of the ILR for the diagnosis of syncope of unknown origin after conventional management in clinical practice. Methods We reviewed the results with ILR implantation in patients with syncope of unknown origin after conventional management in the cardiology department at HU Marques de Valdecilla (Santander, Cantabria, Spain). Results One hundred and forty patients (age 64 ± 16 y; 86 male [62%]) with syncope of unknown etiology after conventional work‐up underwent prolonged monitoring with an ILR from September 1998 to February 2006; 46 patients (33%) had structural heart disease. During a mean follow‐up of 346 ± 160 d, 51 patients (36.5%) had recurrent syncope with diagnostic ECG recording. An arrhythmic cause for syncope was found in 33 of them (64.5%), with bradycardia present in 27 (53%) and tachycardia in 6 (11%). There were no sudden deaths, and 1 patient suffered a complication related to a recurrence of syncope. Conclusion Long‐time experience with the ILR confirmed the utility of this device in the diagnosis of unexplained syncope in clinical practice. Most of these patients had syncope of arrhythmogenic etiology that could be successfully treated. This strategy of prolonged monitoring is safe even in patients with structural heart disease. Copyright © 2009 Wiley Periodicals, Inc.