title: Electrophysiological characteristics of focal atrial tachycardia surrounding the aortic coronary cusps.
abstract: BACKGROUND
  Catheter ablation of atrial tachycardia (AT) arising near the coronary cusps has been reported in limited numbers of patients. We investigated the electrophysiological characteristics of these ATs in 22 consecutive patients.
  
  
  RESULTS
  This study included 22 patients (mean age ± SD, 53 ± 11 years; 86% female) with ATs arising near the aortic coronary cusps who underwent successful ablation. Activation mapping was performed during tachycardia to identify the earliest activation site. All patients achieved successful ablation through either a retrograde aortic (n=19) or a transseptal (n=3) approach. The successful ablation sites were located in the noncoronary cusp (NCC) (n=16), including 3 near the junction between the NCC and right coronary cusp. The remaining 6 cases were ablated from the left coronary cusp (LCC) (n=3) or the left atrium posterior to the LCC (n=3). For most tachycardias, there were distinctive P-wave morphological features recorded for each cusp location. Furthermore, analysis of the electrogram morphological features recorded during tachycardia at successful ablation sites revealed an atrial/ventricular (A/V) ratio >1 in 14 of 16 NCC ATs; the remaining 2, from the NCC near the junction with the right coronary cusp, showed an A/V ratio ≤ 1. At ablation sites in the LCC, the A/V ratio was <1 (4 of 6 patients) or 1 (remaining 2 patients). During a follow-up duration of 30 ± 13 months, all patients were free of arrhythmias without antiarrhythmic drugs.
  
  
  CONCLUSIONS
  ATs surrounding the aortic coronary cusps can be safely and effectively ablated, with good long-term outcomes. In addition to the P-wave morphological features, the A/V ratio of the local electrogram recording during tachycardia facilitated the localization of successful sites.
authors: Department of Cardiology, Shenyang Northern Hospital, Shenyang, People's Republic of China.
authors: Zulu
authors: Z
authors: Wang
authors: Tong
authors: T
authors: Liu
authors: Michael
authors: M
authors: Shehata
authors: Yanchun
authors: Y
authors: Liang
authors: Zhiqing
authors: Z
authors: Jin
authors: Ming
authors: M
authors: Liang
authors: Yaling
authors: Y
authors: Han
authors: Allen
authors: A
authors: Amorn
authors: Xiushi
authors: X
authors: Liu
authors: Enzhao
authors: E
authors: Liu
authors: Sumeet S
authors: SS
authors: Chugh
authors: Xunzhang
authors: X
authors: Wang
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000503:physiopathology* / Q000601:surgery; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation; D002681:China; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006329:Heart Conduction System / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012850:Sinus of Valsalva / Q000503:physiopathology; D013617:Tachycardia, Supraventricular / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome