Yonsei Med J.  2014 Mar;55(2):530-534.

Atrial Tachycardia Originating from the Aortomitral Junction

• Lee SH
• Shim J
• Pak HN
• Lee MH
• Joung B

Abstract

Atrial tachycardia (AT) originating from the aortomitral junction is a very rare and challenging disease. Its arrhythmic characteristics have not been described in detail compared with the descriptions of the arrhythmic characteristics of AT originating from the other locations. Only a few case reports have documented successful ablation of this type of AT using transaortic or transseptal approaches. We describe a case with AT that was resistant to right-sided ablation near the His bundle failed and transaortic ablation at the aortomitral junction successfully eliminated.

Keyword

Atrial tachycardia; electrophysiological study; radiofrequency catheter ablation

MeSH Terms

Bundle of His
Catheter Ablation
Tachycardia*

Figure

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  Fig. 1 Surface 12-lead electrocardiogram during an episode of palpitation, showing a narrow QRS complex tachycardia with a cycle length of 350 ms. The P-wave polarity preceding the QRS complex was isoelectric in lead I and biphasic in leads V1 and V3.

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  Fig. 2 Intracardiac electrograms and ablation signal at the earliest mapped location in the aortomitral junction. The earliest atrial activation (arrow) was found at the aortomitral junction, where the local electrogram recorded from the distal electrodes of the ablation catheter during tachycardia preceded the onset of the surface P wave by 70 ms. Note that the earliest atrial electrogram recorded from the distal ablation catheter (ABLd) also has a large ventricular potential. Tachycardia was terminated 12 s after radiofrequency application. RA, right atrium; CS, coronary sinus; RV, right ventricle.

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  Fig. 3 Fluoroscopic images in orthogonal fluoroscopic view. (A and B) The successful catheter ablation (ABL) site in the right anterior oblique (RAO) and left anterior oblique (LAO) views, located in the aortomitral junction. (C and D) Aortic root angiograms taken from a pigtail catheter placed at the right coronary cusp (RCC), with the same fluoroscopic angles before ablation. In the RAO view, the RCC overlaps with the left coronary cusp (LCC), and the most anterior aspect is the junction of RCC/LCC. In this view, the NCC is located at the most posterior aspect of the aorta. In the LAO view, the RCC overlaps with the NCC, and the most rightward aspect is the junction of NCC/RCC. The LCC is located at the most leftward aspect in this view. Another mapping catheter (Map) in the RA positioned at the unsuccessful ablation site near the right His-bundle region. CS, coronary sinus; RV, right ventricle; NCC, non-coronary cusp.

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