Reappraisal and new observations on atrial tachycardia ablated from the non-coronary aortic sinus of Valsalva

Shomu Bohora*, Yash Lokhandwala, Eduardo Back Sternick, Robert H. Anderson, Hein J. J. Wellens

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

14 Citations (Web of Science)

Abstract

The clinical characteristics of atrial tachycardias (AT) ablated from the non-coronary aortic sinus (NCS) are thus far described only in small series. We aimed to outline, in a large cohort of patients, the clinical, electrocardiographic, electrophysiological characteristics of this tachycardia. We analysed data pertaining to clinical, electrocardiographic, and electrophysiological characteristics of 43 consecutive patients from an overall cohort of 441 with AT who were successfully ablated from the NCS. The tachycardias ablated from the NCS were paroxysmal (98%) and adenosine sensitive (35/35). The patients were aged 54.6 +/- 12.4 years, showing female preponderance (74%). No P wave pattern was predictive of the location of ablation. Electrophysiological findings suggested a possible micro-reentrant mechanism. During tachycardia, atrial electrograms recorded in the NCS preceded the A in the His region by 10.9 +/- 7.4 ms. Fractionated atrial electrograms were noted at the site of ablation in 42 patients during the tachycardia. Radiofrequency ablation terminated the tachycardia within 5 s in 88%, with thermal automaticity seen only in 3 patients. The site of ablation at the base of the NCS was adjacent to the presumed site of the retroaortic node, a remnant of the initial atrio-ventricular canal musculature. AT ablated from the NCS is a paroxysmal arrhythmia in middle-aged women, with distinct electrocardiographic and electrophysiological characteristics. We suspect the retroaortic node to be involved in the tachycardia circuit.
Original languageEnglish
Pages (from-to)124-133
Number of pages10
JournalEP Europace
Volume20
Issue number1
DOIs
Publication statusPublished - 1 Jan 2018

Keywords

  • Non-coronary aortic sinus aEuro cent Aortic sinus of Valsalva aEuro cent Atrial tachycardia aEuro cent Catheter ablation aEuro cent Retroaortic node aEuro cent Left bundle branch block
  • CATHETER ABLATION
  • ELECTROPHYSIOLOGICAL CHARACTERISTICS
  • REENTRANT TACHYCARDIA
  • CUSP
  • ACTIVATION
  • SUBSTRATE
  • VALVE
  • SITE

Cite this