Catheter Ablation of Peri‐AV Nodal Atrial Tachycardia from the Noncoronary Cusp of the Aortic Valve

Das, Saumya; Neužil, Petr; Chen, Albert; d’Ávila, André; Mansour, Moussa; Mela, Theofanie; Ellinor, Patrick T.; Singh, Jagmeet P.; Patton, Kristen K.; Ruskin, Jeremy N.; Reddy, Vivek Y.

doi:10.1111/j.1540-8167.2007.01024.x

Cited by 62 publications

(68 citation statements)

References 23 publications

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“…The results of our data and previous reports [1][2][3][4][5][6] demonstrate the following findings: (1) When the earliest atrial activation is found at the RA anteroseptum during mapping in the right atrium and when that site is close to the AVN or His-bundle region, the NSV mapping should always be kept in mind; and (2) When the His-bundle deflection is also recorded at that site, the NSV mapping and a comparison of the timing of the local electrograms at the RA anteroseptum with that of the NSV should be performed.…”

Section: Discussionsupporting

confidence: 79%

“…[1][2][3][4][5][6] However, indeed, 1 case that resulted in a complete AV block from the RF energy delivery at the NSV was reported. 7 Therefore, the RF ablation at the NSV might carry a risk of impairing the AV conduction, and much attention should be paid to the delivery of the RF energy at that site.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6] In such a situation, RF ablation at the NSV might eliminate the tachycardia with no complications. [1][2][3][4][5][6] However, because of the vicinity to the AVN and His-bundle region, the RF catheter ablation at the NSV always carries the risk of impairing the conduction of the AVN. In fact, the first case report of RF ablation from the NSV was a case in which a complete AV block was created by the RF ablation from the NSV.…”

mentioning

confidence: 99%

“…[1][2][3][4][5][6] We have also reported 2 cases of supraventricular tachycardias, which consisted of an atrial tachycardia (AT) 1 and atrioventricular (AV) orthodromic tachycardia (AVRT). 2 However, the characteristics of the electrograms recorded from the NSV during normal sinus rhythm as well as during the tachycardia have not been sufficiently examined.…”

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confidence: 99%

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Quantitative Analysis and Characteristics of the Electrograms Recorded Within the Non-Coronary Aortic Sinus of Valsalva

Hiramatsu

Tada

Sakamoto

et al. 2009

Circ J

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Circ J 2009; 73: 838 -845 ecent studies have demonstrated that some supraventricular tachycardias that have their origins near the atrioventricular node (AVN) or His-bundle region can be eliminated by radiofrequency (RF) catheter ablation from the non-coronary sinus of Valsalva (NSV). [1][2][3][4][5][6] We have also reported 2 cases of supraventricular tachycardias, which consisted of an atrial tachycardia (AT) 1 and atrioventricular (AV) orthodromic tachycardia (AVRT). 2 However, the characteristics of the electrograms recorded from the NSV during normal sinus rhythm as well as during the tachycardia have not been sufficiently examined. Furthermore, the difference between the electrograms recorded from the NSV and those recorded from the other 2 aortic sinuses of Valsalva has not been clarified.Even if an early atrial activation during the tachycardia is found on the right atrial (RA) anteroseptum, sufficient deliveries of the RF energy at that site might be impossible because of the high risk for the impairment of the AV conduction. [1][2][3][4][5][6] In such a situation, RF ablation at the NSV might eliminate the tachycardia with no complications. [1][2][3][4][5][6] However, because of the vicinity to the AVN and His-bundle region, the RF catheter ablation at the NSV always carries the risk of impairing the conduction of the AVN. In fact, the first case report of RF ablation from the NSV was a case in which a complete AV block was created by the RF ablation from the NSV. 7 However, the detailed information on the distance from the NSV to the AVN or His-bundle region or the prevalence of recording a His-bundle potential at the NSV, both of which seem to be very important to estimate the risk of AVN conduction block during the RF energy application from the NSV, 8,9 was lacking. Accordingly, in the present study, we performed a quantitative measurement of the electrograms recorded from the aortic sinus of Valsalva during sinus rhythm and/or the tachycardia to clarify those points. Methods Study Population and ProtocolThis study consisted of 3 protocols as follows. Protocol I: Recording of the NSV Electrograms in Patients With Supraventricular TachycardiaThe mapping and recording of the NSV electrograms were performed during sinus rhythm as well as during the tachycardia in 5 patients with paroxysmal supraventricular tachycardia (3 women; mean age, 64±12 years) in whom successful elimination of the tachycardia could be achieved by an RF energy (Received September 16, 2008; revised manuscript received December 5, 2008; accepted January 4, 2009; released online March 31, 2009 Background: Some supraventricular tachycardias could be ablated from the non-coronary sinus of Valsalva (NSV). However, the characteristics of the NSV electrograms have not been clarified. Methods and Results:A quantitative analysis of the NSV electrograms was performed in 5 patients with tachycardias arising from near the atrioventricular node (AVN) and the His-bundle region, and in 20 control subjects. In another 7 control subjects, th...

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Quantitative Analysis and Characteristics of the Electrograms Recorded Within the Non-Coronary Aortic Sinus of Valsalva

Hiramatsu

Tada

Sakamoto

et al. 2009

Circ J

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“…[1][2][3][4][5][6][7] The location of successful ablation targets includes the noncoronary cusp (NCC) in most case series [1][2][3][4][5] and the left coronary cusp (LCC) in a few case reports. 6,7 To date, larger studies that investigate the electrophysiological characteristics and the safety and efficacy of catheter ablation of these ATs are still lacking.…”

mentioning

confidence: 99%

Electrophysiological Characteristics of Focal Atrial Tachycardia Surrounding the Aortic Coronary Cusps

Wang

Liu

Shehata

et al. 2011

Circ: Arrhythmia and Electrophysiology

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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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Mapping and Ablation of Atrial Tachycardia

2019

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Catheter Ablation of Peri‐AV Nodal Atrial Tachycardia from the Noncoronary Cusp of the Aortic Valve

Abstract: Catheter ablation from within the base of the NCC represents a safe and effective means to eliminate focal AT arising from the peri-AV nodal region.

Cited by 62 publications

References 23 publications

Quantitative Analysis and Characteristics of the Electrograms Recorded Within the Non-Coronary Aortic Sinus of Valsalva

Quantitative Analysis and Characteristics of the Electrograms Recorded Within the Non-Coronary Aortic Sinus of Valsalva

Electrophysiological Characteristics of Focal Atrial Tachycardia Surrounding the Aortic Coronary Cusps

Mapping and Ablation of Atrial Tachycardia

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