A small amount of heart tissue is usually cauterized within a few weeks of cardioversion to prevent atrial flutter in the long term. Doctors insert a thin tube called a catheter into a vein through an incision in the groin. They then push special instruments through the catheter up to the heart. The tissue there is heated up using electricity and then destroyed; in rare cases extreme cold is used instead. Experts call this procedure catheter ablation.
A local anesthetic in the groin and a short, mild anesthetic used while the tissue is being destroyed are typically enough. You will usually stay overnight at the hospital after the procedure. The possible risks are bleeding, stroke, heart rhythm disorders and damage to heart or other tissue. Overall, about 20 out of 1,000 people develop severe complications, and 2 out of 1,000 people die as a result of the procedure.
In typical atrial flutter, the area right between the inferior vena cava and the heart valve that connects the right atrium and the right ventricle is usually destroyed. Experts refer to that small piece of tissue as the cavotricuspid isthmus (CTI). In typical atrial flutter, the stimulating signal repeatedly circles that spot. That is no longer possible if that area is scarred after some of the tissue has been destroyed.
CTI ablation can effectively stop atrial flutter from returning in about 90 percent of people with typical atrial flutter. But atrial fibrillation, the other, more common heart disorder that occurs in the atrium, can still develop at a later stage.
There are also types of atrial flutter where the narrow part between the vena cava and the heart valve is not involved. That is referred to as atypical atrial flutter. Ablation can help here, too, but the chances of success are lower than for typical atrial flutter. This procedure is normally carried out in a specialist heart clinic. They can check where the abnormal signals are coming from before and during the procedure to work out which parts of the atria have to be destroyed.