Focal atrial tachycardia originating from the non-coronary aortic sinus: electrophysiological characteristics and catheter ablation.
OBJECTIVE
We sought to investigate electrophysiological characteristics and catheter ablation in patients with focal atrial tachycardia (AT) originating from the non-coronary aortic sinus (AS).


BACKGROUND
In patients with failed ablation of focal AT near the His bundle (HB) region, an origin from the non-coronary AS should be considered because of the close anatomical relationship.


METHODS
This study included 9 patients with focal AT, in 6 of whom attempted radiofrequency (RF) ablation had previously failed. Activation mapping was performed during tachycardia to identify an earliest activation in the atria and the AS. The aortic root angiography was performed to identify the origin in the AS before RF ablation.


RESULTS
Focal AT was reproducibly induced by atrial pacing. Mapping in atria demonstrated that the earliest atrial activation was located at the HB region, whereas mapping in the non-coronary AS demonstrated that an earliest atrial activation preceded the atrial activation at the HB by 12.2 +/- 6.9 ms and was anatomically located superoposterior to the HB in all 9 patients. Also, His potentials were not found at the successful site in the non-coronary AS in all 9 patients. The focal AT was terminated in <8 s in all 9 patients. Junctional beats and PR prolongation did not occur during RF application in all 9 patients. No complications occurred in any of the nine patients. All 9 patients were free of arrhythmias without antiarrhythmic drugs during a follow-up of 9 +/- 3 months.


CONCLUSIONS
In patients with focal AT near the HB region, mapping in the non-coronary AS can improve clinical outcome.
Ouyang
Feifan
F
II. Medizinische Abteilung, Allgemeines Krankenhaus St. Georg, Hamburg, Germany. Ouyangfeifan@aol.com
Ma
Jian
J
Ho
Siew Yen
SY
Bänsch
Dietmar
D
Schmidt
Boris
B
Ernst
Sabine
S
Kuck
Karl-Heinz
KH
Liu
Shaowen
S
Huang
He
H
Chen
Min
M
Chun
Julian
J
Xia
Yunlong
Y
Satomi
Kazuhiro
K
Chu
Huimin
H
Zhang
Shu
S
Antz
Matthias
M
D000328:Adult; D000368:Aged; D002036:Bundle of His / Q000503:physiopathology; D017115:Catheter Ablation; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012850:Sinus of Valsalva / Q000503:physiopathology; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000503:physiopathology / Q000601:surgery; D013612:Tachycardia, Ectopic Atrial / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*