Successful Ablation of Atrial Tachycardia in the Right Coronary Cusp of the Aortic Valve in a Patient with Atrial Fibrillation: What is the Substrate?


  • Manuscript received 10 September 2007; Revised manuscript received 7 December 2007; Accepted for publication 10 December 2007.

Address for correspondence: Samuel J. Asirvatham, M.D., Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA. Fax: 507-255-2550; E-mail:


Atrial tachycardias have been successfully ablated from the noncoronary cusp of the aortic valve. The anatomical substrate responsible for the arrhythmia in these patients is unknown. We report a case of intracardiac ultrasound confirmed ablation in the right coronary cusp of the aortic valve. Pacing maneuvers performed in this case, along with the regional anatomy of the right coronary cusp, strongly suggest that the ablated substrate is muscular extensions above the aortic valve. Ablation in the right coronary cusp eliminated tachycardia without valve damage or AV conduction abnormality.