title: Comparison of strategies for catheter ablation of focal atrial tachycardia originating near the His bundle region.
abstract: Recent studies have suggested that para-Hisian atrial tachycardia (AT) can be successfully ablated from the right atrium (RA), left atrium (LA), or noncoronary cusp (NCC) in the aorta; however, the best approach remains unclear.
  
  
  
  This study aimed to compare different approaches to radiofrequency catheter ablation (RFCA) of para-Hisian AT.
  
  
  
  We retrospectively analyzed 68 consecutive patients (49[72%] women; mean age 61 ± 13 years) treated with RFCA for this type of AT. Mapping of the RA (n = 68), LA (n = 21), and NCC (n = 52) was performed during AT to identify the earliest activation site and to apply RFCA.
  
  
  
  RFCA successfully terminated AT in the RA in 13 of 28 patients (46.4%), in the LA in 4 of 16 patients (25.0%), and in the NCC in 46 of 52 patients (88.5%) after 1 procedure (P < .05). Atrioventricular block occurred only during RFCA in the RA in 4 of 28 patients (14.3%). After a mean follow-up of 33.5 ± 25.4 months, AT recurrence was observed in 5 of 13 patients (38.5%) ablated in the RA, 1 of 4 (25.0%) ablated in the LA, and 2 of 46 (4.4%) ablated in the NCC (P < .05). RFCA in the LA was effective only if the local activation time (LAT) was earlier than that in the RA. RFCA in the NCC was successful regardless of the LAT (P < .05).
  
  
  
  Mapping and ablation in the NCC should be always considered in cases of AT originating from the His bundle region, regardless of the LAT.
authors.affiliation: Mechnikov North-West State Medical University, Saint Petersburg, Russia. Electronic address: lyanevgeny@gmail.com.
authors.forename: Evgeny
authors.initials: E
authors.lastname: Lyan
authors.affiliation: Cardiology Division, University Hospital "S. Maria della Misericordia", Udine, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Toniolo
authors.affiliation: Petrovsky National Research Centre of Surgery, Moscow, Russia.
authors.forename: Alexey
authors.initials: A
authors.lastname: Tsyganov
authors.affiliation: Cardiology Division, University Hospital "S. Maria della Misericordia", Udine, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Rebellato
authors.affiliation: Cardiology Division, University Hospital "S. Maria della Misericordia", Udine, Italy; IRCAB Foundation, Udine, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Proclemer
authors.affiliation: Cardiology Division, Ospedale Generale Regionale, Bolzano, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Manfrin
authors.affiliation: Federal Centre for Cardiovascular Surgery, Astrakhan, Russia.
authors.forename: Anatoly
authors.initials: A
authors.lastname: Nechepurenko
authors.affiliation: First Pavlov State Medical University, Saint Petersburg, Russia.
authors.forename: Alexandr
authors.initials: A
authors.lastname: Morozov
authors.affiliation: National Scientific Cardiac Surgery Centre, Astana, Kazakhstan.
authors.forename: Ayan
authors.initials: A
authors.lastname: Abdrahmanov
authors.affiliation: Burdenko Main Military Hospital, Moscow, Russia.
authors.forename: Grigory
authors.initials: G
authors.lastname: Gromyko
authors.affiliation: Federal Centre of High Medical Technologies, Kaliningrad, Russia.
authors.forename: Vitaly
authors.initials: V
authors.lastname: Lyashenko
authors.affiliation: Petrovsky National Research Centre of Surgery, Moscow, Russia.
authors.forename: Marina
authors.initials: M
authors.lastname: Yakovleva
mesh_terms: D000368:Aged; D001011:Aorta / Q000601:surgery; D054537:Atrioventricular Block / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D002036:Bundle of His / Q000503:physiopathology; D017115:Catheter Ablation / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000517:prevention & control; D007558:Italy; D007623:Kazakhstan; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012008:Recurrence; D012189:Retrospective Studies; D012426:Russia; D013612:Tachycardia, Ectopic Atrial / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery
keywords: AV block; His bundle; Mapping; Noncoronary aortic cusp; Perinodal atrial tachycardia; Radiofrequency ablation