Efficacy of Radiofrequency Ablation of Atrial Tachycardia Originating From the Non-coronary Aortic Cusp Guided by Three-dimensional Mapping in 11 Patients / 中国循环杂志

ABSTRACT

Objectives: To analyze the electrophysiological mapping characteristic and evaluate the effect of radiofrequency ablation in atrial tachycardia (AT) originating from the non-coronary aortic cusp (NCC). Methods: Data from 11 patients with AT originated from NCC and underwent electrophysiological mapping and radiofrequency ablation under the guidance of three-dimensional mapping system were analyzed. The electrical anatomical model of right atrium, His bundle and the root of the aorta was constructed during the procedure to measure the distance between the earliest atrial activation and His bundle. Ablation was performed at the earliest atrial activation site. Results: Cardiac electrophysiological examination evidenced the focal originating of AT in all 11 cases, right atrial activation mapping showed that all the earliest activation site was located in the left or left upper posterior of His bundle, activation time was (21.0 ± 7.9) ms prior to coronary sinus proximal reference wave A, the distance between the earliest activation site and the His bundle was (6.9 ± 3.4) mm. Aortic root mapping showed that the earliest activation sites were all located in the NCC, activation time was (35.0 ± 8.6) ms prior to coronary sinus proximal reference wave A, the distance between the earliest activation site and His bundle was (7.3 ± 4.6) mm. AT in all 11 patients were terminated after ablation, Post ablation, AT could no longer be induced by repeated stimulations. No atrioventricular conduction block occurred during and after operation. No AT recurrences were observed in all 11 patients during the 6 months follow-up. Conclusions: The success rate and safety of three-dimensional mapping guided ablation of AT originated from NCC are high. The main point of the mapping, which is crucial for the successful ablation, is that if the earliest atrial activation site of AT is located at left or left upper posterior of His bundle, it is mandatory to perform aortic root mapping and to routinely determine whether NCC is the earliest activation site of AT.