CTI ablation is highly effective for typical atrial flutter, but post-ablation atrial fibrillation is a common occurrence requiring additional management.
The cavotricuspid isthmus (CTI) had a complex architecture with an anisotropic conduction property. An incremental pacing from the low right atrial isthmus produced a conduction delay and block, and initiated atrial flutter. Radiofrequency catheter ablation of the CTI was very effective in eliminating the typical atrial flutter. However, atrial fibrillation often occurred after ablation of the isthmus and needs further treatment.
Tai et al. (Mon,) studied this question.