Cavotricuspid isthmus ablation for atrial flutter: Anatomic challenges and troubleshooting

In patients with cavotricuspid isthmus (CTI)-dependent atrial flutter, ablation along the CTI is often a routine and straightforward procedure. However, certain aspects of the regional anatomy can pose technical challenges such that bidirectional block across the CTI can be difficult to achieve.1 Using a case example, we review common challenges with CTI ablation, discuss the important anatomic considerations that are relevant to procedural difficulty, and present approaches to troubleshooting.