title: Ablation of focal atrial tachycardia from the non-coronary aortic cusp: case series and review of the literature.
abstract: OBJECTIVE
  Focal atrial tachycardia successfully ablated from the non-coronary cusp (NCC) is rare. Our aim was to describe the characteristics of mapping and ablation therapy of NCC focal atrial tachycardias and to provide a comprehensive review of the literature.
  
  
  RESULTS
  Seven patients (age 40 ± 9 years) with symptomatic, drug-refractory atrial tachycardia were referred for electrophysiological study. Extensive right and left atrial mapping revealed atrial tachycardia near His in all patients but either failed to identify a successful ablation site or radiofrequency applications only resulted in temporary termination of the tachycardia. Mapping and ablation of the NCC were performed retrogradely via the right femoral artery. Mapping of the NCC demonstrated earliest atrial activation during atrial tachycardia 38 ± 14 ms (ranging 17-56 ms) before the onset of the P-wave. Earliest atrial activation in the NCC was earlier than earliest activation in the right atrium and left atrium in all patients. The P-wave morphology was predominantly negative in the inferior leads and biphasic in leads V1 and V2. The tachycardia was successfully terminated by radiofrequency application in 10 ± 6 s (2-16 s), without complications. All patients were free of symptoms during a follow-up of 19 ± 9 months. Literature search revealed 18 reports (91 patients) describing NCC focal atrial tachycardia, with 99% long-term ablation success with a 1% complication rate.
  
  
  CONCLUSIONS
  Symptomatic focal atrial tachycardia near His may originate from the NCC and can be treated safely and effectively with radiofrequency ablation.
authors.affiliation: Department of Cardiology, Isala Klinieken, Dr Van Heesweg 2, 8025 AB Zwolle, The Netherlands.
authors.forename: Rypko J
authors.initials: RJ
authors.lastname: Beukema
authors.affiliation: Department of Cardiology, Isala Klinieken, Dr Van Heesweg 2, 8025 AB Zwolle, The Netherlands.
authors.forename: Jaap Jan J
authors.initials: JJ
authors.lastname: Smit
authors.affiliation: Department of Cardiology, Isala Klinieken, Dr Van Heesweg 2, 8025 AB Zwolle, The Netherlands.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Adiyaman
authors.affiliation: Department of Cardiology, Isala Klinieken, Dr Van Heesweg 2, 8025 AB Zwolle, The Netherlands.
authors.forename: Lieve
authors.initials: L
authors.lastname: Van Casteren
authors.affiliation: Department of Cardiology, Isala Klinieken, Dr Van Heesweg 2, 8025 AB Zwolle, The Netherlands.
authors.forename: Peter Paul H M
authors.initials: PP
authors.lastname: Delnoy
authors.affiliation: Department of Cardiology, Isala Klinieken, Dr Van Heesweg 2, 8025 AB Zwolle, The Netherlands.
authors.forename: Anand R
authors.initials: AR
authors.lastname: Ramdat Misier
authors.affiliation: Department of Cardiology, Isala Klinieken, Dr Van Heesweg 2, 8025 AB Zwolle, The Netherlands v.r.c.derks@isala.nl.
authors.forename: Arif
authors.initials: A
authors.lastname: Elvan
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D002036:Bundle of His / Q000503:physiopathology*; D017115:Catheter Ablation; D056149:Epicardial Mapping; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013612:Tachycardia, Ectopic Atrial / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*
keywords: Ablation; Aortic cusp; Atrial tachycardia; Electrocardiography; Mapping