title: Efficacy and Safety of Catheter Ablation of Atrial Tachycardia Through a Direct Approach from Noncoronary Sinus of Valsalva.
abstract: Noncoronary aortic cusp (NCAC) in the aorta represents a challenging location for catheter ablation of focal atrial tachycardias (ATs) arising near the His-bundle region. The purpose of this study was to provide an updated report on the methods, efficacy, and safety of catheter ablation of ATs originating from NCAC. The study population includes 23 patients (18 women [78%], mean age 65 ± 12 years) with highly symptomatic AT. The atrial mapping was performed during tachycardia to define the earliest atrial activation site. Electrophysiological mapping of the right atrium was initially performed, followed by aortic root mapping when earliest activation was recorded in the proximal electrode of the His-bundle catheter. A direct ablation approach from NCAC was used in every patient independently by the local activation time. Ablations were performed using a steerable 4-mm tip nonirrigated catheter in all patients. Radiofrequency energy resulted in the disappearance of arrhythmias in 22 of the 23 patients (95%). In all procedures, there were no complications. During a mean follow-up of 41 ± 25 months, no patient presented with a recurrence, except the 1 patient where the ablation was not effective. In conclusion, catheter ablation of para-hisian ATs through a direct approach from NCAC shows to be safe and effective after 1 procedure per patient.
authors.affiliation: Division of Cardiology, University Hospital "S.Maria della Misericordia", Udine, Italy. Electronic address: toniolomauro0@gmail.com.
authors.forename: Mauro
authors.initials: M
authors.lastname: Toniolo
authors.affiliation: Division of Cardiology, University Hospital "S.Maria della Misericordia", Udine, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Rebellato
authors.affiliation: Division of Cardiology, University Hospital "S.Maria della Misericordia", Udine, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Poli
authors.affiliation: Division of Cardiology, University Hospital "S.Maria della Misericordia", Udine, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Daleffe
authors.affiliation: Division of Cardiology, University Hospital "S.Maria della Misericordia", Udine, Italy; I.R.C.A.B. Foundation, Udine, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Proclemer
mesh_terms: D000368:Aged; D001011:Aorta; D002036:Bundle of His; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012850:Sinus of Valsalva / Q000601:surgery*; D013612:Tachycardia, Ectopic Atrial / Q000601:surgery*