Korean Circ J.
2022 Jul;52(7):513-526. 10.4070/kcj.2021.0388.
Prevalence and Characteristics of Atrial Tachycardia From Noncoronary Aortic Cusp During Atrial Fibrillation Catheter Ablation
- Cha MJ
1 - Kim J1
- Park YJ2
- Cho MS1
- Park HS3
- Kwon S4
- Lee YS5
- Ahn J6
- Choi HO7
- Park JS8
- Hwang Y9
- Choi JH10
- Hwang KW10
- Kim YR11
- Han S3
- Oh S4
- Nam GB1
- Choi KJ1
- Pak HN2
- Affiliations
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- 1Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- 2Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- 3Division of Cardiology, Department of Internal Medicine, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
- 4Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- 5Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea
- 6Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
- 7Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
- 8Division of Cardiology, Department of Internal Medicine, Dong-A University Hospital, Busan, Korea
- 9Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, ST. Vincent’s Hospital, Suwon, Korea
- 10Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- 11Division of Cardiology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
- KMID: 2530732
- DOI: http://doi.org/10.4070/kcj.2021.0388
Abstract
- Background and Objectives
Atrial tachycardias (ATs) from noncoronary aortic cusp (NCC) uncovered after radiofrequency ablation for atrial fibrillation (AF) are rarely reported. This study was conducted to investigate the prevalence and clinical characteristics of NCC ATs detected during AF ablation and compare their characteristics with de novo NCC ATs without AF.
Methods
Consecutive patients who underwent radiofrequency catheter ablation for AF were reviewed from the multicenter AF ablation registry of 11 tertiary hospitals. The clinical and electrophysiological characteristics of NCC AT newly detected during AF ablation were compared with its comparators (de novo NCC AT ablation cases without AF).
Results
Among 10,178 AF cases, including 1,301 redo ablation cases, 8 (0.08%) NCC AT cases were discovered after pulmonary vein isolation (PVI; 0.07% in first ablation and 0.15% in redo ablation cases). All ATs were reproducibly inducible spontaneously or with programmed atrial stimulation without isoproterenol infusion. The P-wave morphological features of tachycardia were variable depending on the case, and most cases exhibited 1:1 atrioventricular conduction. AF recurrence rate after PVI and NCC AT successful ablation was 12.5% (1 of 8). Tachycardia cycle length was shorter than that of 17 de novo ATs from NCC (303 versus 378, p=0.012). No AV block occurred during and after successful AT ablation.
Conclusions
Uncommon NCC ATs (0.08% in AF ablation cases) uncovered after PVI, showing different characteristics compared to de-novo NCC ATs, should be suspected irrespective of P-wave morphologies when AT shows broad propagation from the anterior interatrial septum.
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