title: Potential anatomic substrate of peri-atrioventricular nodal atrial tachycardia ablated from the noncoronary sinus of Valsalva.
abstract: BACKGROUND
  Although focal atrial tachycardia (AT) is known to sometimes be ablated from the noncoronary aortic cusp (NCC), the electro-anatomic characteristics of NCC-AT are not well known.
  
  
  METHODS
  We compared the clinical, 12-lead electrocardiogram (ECG), and transthoracic echocardiogram characteristics of 6 women (median age, 66.5 years) with NCC-AT and 12 age-matched women (median age, 64.0 years) with atrioventricular nodal reentrant tachycardia (AVNRT) as the control group.
  
  
  RESULTS
  There was no difference in the prevalence of hypertension between the two groups (67 vs. 33 %, respectively, P = 0.3213). The resting ECG of the NCC-AT group vs. that of the AVNRT group showed a significantly longer PQ interval (170.0 (interquartile range (IQR), 157.5-180.0 ms) vs. 140.0 ms (IQR, 122.5-147.5 ms), P = 0.0010) and leftward shifting of the QRS axis (4° (IQR, -26.0° to 24.0°) vs. 57° (IQR, 43.0-70.2°), P = 0.0087). The upper interventricular septum (IVS) thickness was significantly greater (15.6 (IQR, 11.9-18.7 ms) vs. 11.7 mm (IQR, 10.2-12.9 ms), P = 0.0393), and the angle formed by the aortic roof and IVS (AS angle) was significantly steeper (103.0° (IQR, 94.2-119.2°) vs. 122.5° (IQR, 108.5-128.5°), P = 0.0343) in the NCC-AT group than in the AVNRT group.
  
  
  CONCLUSIONS
  Our data suggest that NCC-AT is characterized by a longer atrioventricular (AV) conduction time, steeper AS angle, and thicker IVS than are seen with AVNRT. These electrocardiographic and echocardiographic characteristics from the IVS to the peri-AV nodal regions may have some effect on the development of NCC-AT.
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kami cho, Itabashi-ku, Tokyo, 173-8610, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Mano
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Okumura
authors.forename: Ichiro
authors.initials: I
authors.lastname: Watanabe
authors.forename: Naoko
authors.initials: N
authors.lastname: Sasaki
authors.forename: Rikitake
authors.initials: R
authors.lastname: Kogawa
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Sonoda
authors.forename: Koichi
authors.initials: K
authors.lastname: Nagashima
authors.forename: Hironori
authors.initials: H
authors.lastname: Haruta
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Kofune
authors.forename: Kimie
authors.initials: K
authors.lastname: Ohkubo
authors.forename: Toshiko
authors.initials: T
authors.lastname: Nakai
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hirayama
mesh_terms: D000368:Aged; D018780:Body Surface Potential Mapping; D017115:Catheter Ablation; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D012850:Sinus of Valsalva / Q000503:physiopathology* / Q000601:surgery*; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000503:physiopathology* / Q000601:surgery*; D013612:Tachycardia, Ectopic Atrial / Q000503:physiopathology* / Q000601:surgery; D016896:Treatment Outcome