Successful fluoroless ablation of an incessant atypical atrial flutter attributed to AtriClip usage during mini-MAZE surgery for persistent atrial fibrillation

Introduction The AtriClip left atrial appendage (LAA) exclusion device (AtriCure Inc, Westchester, OH) is a surgical LAA closure device frequently used in conjunction with thoracoscopyguided mini-MAZE surgery to treat atrial fibrillation (AF). It is composed of 2 parallel titanium bars, which provide constant tension when deployed. The AtriClip is coated with polyester fabric, which promotes tissue ingrowth and provides an atraumatic surface, preventing erosion into surrounding structures. There is evidence that epicardial ligation of the LAA may have some antiarrhythmic effect, with reduced AF burden observed in patients who underwent successful LAA exclusion. However, surgical intervention to the left atrium may also carry proarrhythmic potential. In this article, we report a rare case of incessant atypical atrial flutter that appears to be driven by the electrophysiologic remodeling of the local atrial tissue as a result of AtriClip application.