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Background-Catheter ablation of atrial tachycardia (AT) arising near the coronary cusps has been reported in limited numbers of patients. We investigated the electrophysiological characteristics of these ATs in 22 consecutive patients. Methods and Results-This study included 22 patients (mean ageϮSD, 53Ϯ11 years; 86% female) with ATs arising near the aortic coronary cusps who underwent successful ablation. Activation mapping was performed during tachycardia to identify the earliest activation site. All patients achieved successful ablation through either a retrograde aortic (nϭ19) or a transseptal (nϭ3) approach. The successful ablation sites were located in the noncoronary cusp (NCC) (nϭ16), including 3 near the junction between the NCC and right coronary cusp. The remaining 6 cases were ablated from the left coronary cusp (LCC) (nϭ3) or the left atrium posterior to the LCC (nϭ3). For most tachycardias, there were distinctive P-wave morphological features recorded for each cusp location. Furthermore, analysis of the electrogram morphological features recorded during tachycardia at successful ablation sites revealed an atrial/ventricular (A/V) ratio Ͼ1 in 14 of 16 NCC ATs; the remaining 2, from the NCC near the junction with the right coronary cusp, showed an A/V ratio Յ1. At ablation sites in the LCC, the A/V ratio was Ͻ1 (4 of 6 patients) or 1 (remaining 2 patients). During a follow-up duration of 30Ϯ13 months, all patients were free of arrhythmias without antiarrhythmic drugs. Conclusions-ATs surrounding the aortic coronary cusps can be safely and effectively ablated, with good long-term outcomes. In addition to the P-wave morphological features, the A/V ratio of the local electrogram recording during tachycardia facilitated the localization of successful sites. (Circ Arrhythm Electrophysiol. 2011;4:902-908.)

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