Catheter Ablation of Peri-AV Nodal Atrial Tachycardia from the Noncoronary Cusp of the Aortic Valve


  • This work was supported in part as an abstract at the 2004 Annual Scientific Sessions of the Heart Rhythm Society.

  • This work was supported by an NIH K23 award (HL68064–02) to Dr. Reddy and an ACC-Pfizer and Clinical Investigator Training Program: Harvard-MIT Health Sciences and Technology-Beth Israel Deaconess Medical Center in collaboration with Pfizer Inc. and Merck & company Inc. grant to Dr. Das.

  • Manuscript received 1 August 2007; Revised manuscript received 19 September 2007; Accepted for publication 21 September 2007.

Address for correspondence: Vivek Y. Reddy, M.D., Cardiac Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, Gray-Bigelow 109, Boston, MA 02114. Fax: 617-726-0282; E-mail:


Introduction: Atrial tachycardias (AT) originating from the anteroseptal region of the aortic root, near the atrioventricular node can be challenging to eliminate safely by catheter ablation. In this study, we examine the characteristics of anteroseptal ATs in a cohort of patients at our centers, and demonstrate the long-term efficacy and safety of targeting the arrhythmias from within the base of the noncoronary aortic valve cusp (NCC).

Methods & Results: From among a cohort of 54 patients with symptomatic focal AT undergoing invasive electrophysiological evaluation, the point of earliest right atrial (RA) activation was at the peri-AV nodal region in 10 patients, just postero-superior to the His-bundle. Before further mapping, RA lesions placed in two patients were unsuccessful in eliminating the arrhythmia. Because of its proximity to the interatrial septum, the base of the NCC was mapped using a retrograde aortic approach, and revealed a point of early activation without the presence of a His potential. The arrhythmia terminated with <10 seconds of radiofrequency or cryothermal energy delivery and was successfully eliminated in 7 of 10 patients. Transient termination or acceleration of the AT was noted in the other three patients, prompting successful ablation from a left atrial septal position or a reattempt from a para-Hisian RA position. All patients have been arrhythmia free during follow-up (41 ± 12 months).

Conclusions: Catheter ablation from within the base of the NCC represents a safe and effective means to eliminate focal AT arising from the peri-AV nodal region.