Introduction: Atrial flutters induced or converted after pulmonary vein isolation (PVI) for atrial fibrillation ablation include cavotricuspid isthmus (CTI)-, roof-, or peri-mitral (PM) dependent atrial flutter (AFL). The purpose of this study was to describe electrocardiogrphic characteristics of the PM-AFL after PVI. Methods: Patients with PM-AFL after PVI underwent mapping and ablation. Tachycardia origin and mechanisms were determined using electroanatomic mapping and entrainment techniques. Electrocardiographic F wave polarities of PM-AFL in relation with CTI conduction status were reviewed by two different analyzers. Results: This study included 35 patients with PM-AFL with or without CTI ablation [before CTI ablation: clockwise (CW) PM-AFL (7 cases), counterclockwise (CCW) PM-AFL (8 cases), and after CTI ablation: CW PM-AFL (10 cases), CCW PM-AFL (10 cases)]. In all cases, F wave polarity was positive in the pre-cordial leads. For CW PM-AFL before CTI ablation, F wave was negative in the inferior leads and positive in I, aVL, aVR leads. However, in PM-AFL after CTI ablation, F wave was positive in the inferior leads and negative in I, aVL, aVR leads. On the contrary, CCW PM-AFL, F wave was positive in the inferior leads, aVR and negative in I, aVL leads, regardless of CTI conduction status. However some positive/negative direction change in aVR lead was observed after CTI ablation. Conclusions: Electrocardiographic F wave polarities of the inferior leads were opposite according to CTI conduction status for CW PM-AFL, while inferior lead polarities were positive regardless of the isthmus conduction in CCW PM-AFL. In both cases, AFL with negative direction of F wave in the aVR after CTI ablation suggests PM origin if positive polarity of lead V1 was observed.