title: Atrial Tachycardia Originating in the Vicinity of the Noncoronary Sinus of Valsalva: Report of a Series Including the First Case of Ablation-Related Complete Atrioventricular Block.
abstract: BACKGROUND
  A few series of focal atrial tachycardia (AT) originating from the noncoronary sinus of Valsalva (NCSV) have been reported in the literature during the last decade.
  
  
  RESULTS
  Of 147 patients with AT referred for radiofrequency ablation (RFA), we identified nine (6%) originating in the vicinity of the NCSV. Clinical AT was induced during electrophysiological study in all patients without (n = 6) and with (n = 3) isoproterenol infusion. Mean cycle length of the induced tachycardia was 399 ± 85 ms. Mapping of the right atrium and of the left atrium (LA) was initially performed in all nine patients and in four patients, respectively. Earliest tachycardia activation occurred at the His bundle area in all cases. Earliest activations in the LA were at the low paraseptal regions. In two patients with antegrade dual atrioventricular (AV) node physiology that rendered difficult accurate distinction between atrial and ventricular activation, slow pathway ablation was necessary. A retrograde aortic approach was used for mapping the aortic cusps. The earliest local atrial activation in the NCSV preceded the atrial activation in the His area in all patients by 27 ± 8 ms. RFA was performed in all nine patients and was acutely successful in eight. Two patients required radiofrequency (RF) energy outputs of 50 W in order to terminate the arrhythmia. In one patient, successful AT ablation was associated with complete AV block requiring implantation of permanent pacemaker.
  
  
  CONCLUSIONS
  Focal AT can be successfully mapped and ablated in the NCSV. Higher than usual RF energy levels are sometimes required. Complete AV block is a possible complication.
authors.affiliation: Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.|the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Barkagan
authors.affiliation: Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.|the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Yoav
authors.initials: Y
authors.lastname: Michowitz
authors.affiliation: Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.|the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Aharon
authors.initials: A
authors.lastname: Glick
authors.affiliation: Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.|the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Oholi
authors.initials: O
authors.lastname: Tovia-Brodie
authors.affiliation: Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.|the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Raphael
authors.initials: R
authors.lastname: Rosso
authors.affiliation: Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.|the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Bernard
authors.initials: B
authors.lastname: Belhassen
mesh_terms: D000328:Adult; D000368:Aged; D018780:Body Surface Potential Mapping; D017115:Catheter Ablation; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012850:Sinus of Valsalva; D013612:Tachycardia, Ectopic Atrial / Q000503:physiopathology* / Q000628:therapy
keywords: atrial tachycardia; noncoronary sinus of Valsalva; radiofrequency ablation