An anterior ablation line is preferred for perimitral flutter after heart transplant.

Perimitral atrial flutter in cardiac allograft recipients is uncommon. In general, mitral isthmus ablation can be quite challenging in all patients with perimitral flutter, including the subset of patients who present following left atrial ablation for atrial fibrillation. We report 2 cases where an anterior ablation line was easily performed to eliminate perimitral flutter and produce bidirectional block.