Yonsei Med J.  2008 Dec;49(6):1041-1045. 10.3349/ymj.2008.49.6.1041.

Successful Catheter Ablation of Atrial Tachycardia Originating from the Non-coronary Aortic Sinus

• Joung B
• Lee MH
• Kim SS

• KMID: 1782956
• DOI: http://doi.org/10.3349/ymj.2008.49.6.1041

Abstract

We report a rare case of atrial tachycardia originating from the non-coronary aortic sinus. After failed radiofrequency (RF) energy applications at right His-bundle region, the complete elimination of atrial tachycardia was achieved with an RF energy application in the non-coronary aortic sinus. With the review of other papers, this report emphasizes the importance of mapping in the non-coronary aortic sinus in focal atrial tachycardia near the atrioventricular node or near the His-bundle.

Keyword

Atrial tachycardia; non-coronary aortic sinus; catheter ablation

MeSH Terms

Catheter Ablation/*methods
Electrocardiography
Female
Humans
Middle Aged
Tachycardia, Ectopic Atrial/physiopathology/radiography/*therapy

Figure

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  Fig. 1 (A) Twelve-lead electrocardiograms during sinus rhythm (Left) and the tachycardia (Right). (B) The tracings are the ECG leads I, II, V1, and intracardiac electrograms recorded from a mapping catheter, and catheters placed at the HBE, within the CS, and at the RVA during sinus rhythm (Left) and the tachycardia (Right). The local electrogram recorded at the His bundle preceded the onset of the surface P wave by 40 ms. ECG, electrocardiogram; CS, coronary sinus; HBE, His bundle region; RA, right atrium; RVA, right ventricular apex.

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  Fig. 2 The tracings are the ECG leads I, II, V1, and intracardiac electrograms recorded from a mapping catheter positioned in the non-coronary aortic sinus (Non-coro AS 1 to 2, Non-coro AS 3 to 4), and catheters placed at the HBE and left anteroseptum (LA AS 1 to 2, LA AS 3 to 4). (A) The successful site with the earliest RA activation is shown at the non-coronary aortic sinus. Note that the earliest activation preceded the onset of the surface P wave by 55 ms. (B) The atrial tachycardia was successfully terminated after 5.8 seconds during the first radiofrequency application. AS, aortic sinus; the other abbreviations are as in Fig. 1.

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  Fig. 3 Right (30°) and left (45°) oblique radiographic views showing the mapping catheter (Map) located at the successful ablation site in the aortic sinus (A and B), another mapping catheter at the left anteroseptum, and catheters placed at the HBE, in the RA, and in the RV. An aortic root angiogram in the right (30°) and left (45°) oblique radiographic views (C and D) showing the mapping catheter in the non-coronary aortic sinus supero-posterior to the site where the His bundle potential was recording from the distal one to four electrodes. An MRI in the right and left oblique views (E and F) showing the non-coronary aortic sinus. Ao, aorta; L, left aortic sinus; LV, left ventricle; N, non-coronary aortic sinus; R, right aortic sinus; IVS, interventricular septum; the other abbreviations are as in Fig. 1.

Reference

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2. Badhwar N, Kalman J, Sparks PB, Kistler PM, Attari M, Berger M, et al. Atrial tachycardia arising from the coronary sinus musculature: electrophysiological characteristics and long-term outcomes of radiofrequency ablation. J Am Coll Cardiol. 2005. 46:1921–1930.

3. Connors SP, Vora A, Green MS, Tang AS. Radiofrequency ablation of atrial tachycardia originating from the triangle of Koch. Can J Cardiol. 2000. 16:39–43.

4. Chen CC, Tai CT, Chiang CE, Yu WC, Lee SH, Chen YJ, et al. Atrial tachycardias originating from the atrial septum: electrophysiologic characteristics and radiofrequency ablation. J Cardiovasc Electrophysiol. 2000. 11:744–749.

5. Tada H, Naito S, Miyazaki A, Oshima S, Nogami A, Taniguchi K. Successful catheter ablation of atrial tachycardia originating near the atrioventricular node from the noncoronary sinus of Valsalva. Pacing Clin Electrophysiol. 2004. 27:1440–1443.

6. Ouyang F, Ma J, Ho SY, Bänsch D, Schmidt B, Ernst S, et al. Focal atrial tachycardia originating from the non-coronary arortic sinus, electrophysiological characteristics and catheter ablation. J Am Coll Cardiol. 2006. 48:122–131.