Beating-heart ablation of the cavo-tricuspid isthmus

Atrial flutter onset following 'mini-Maze' procedures worsens patient recovery and prolongs hospital-stay. It has been demonstrated that atrial flutter recurrence following isolated left-sided 'mini-Maze' often originates from the right cavo-tricuspid isthmus. We report here a simple procedure to ablate the cavo-tricuspid isthmus, either on cardio-pulmonary bypass and/or off-pump. Two ablation lines were made with an irrigated bipolar radiofrequency clamp, starting from a purse-string suture in front of the coronary sinus toward the coronary sinus and the atrio-ventricular groove, respectively. Another ablation line is directed toward the right appendage. A purse-string suture on the right appendage is used to connect the inferior with the superior vena cava, thus ablating the terminal crest