Risk and benefits of radiofrequency catheter ablation at the aortic cusp for the treatment of para-Hisian supra-ventricular tachyarrhythmias

Abstract

Background The risk and benefit of radiofrequency catheter ablation (RFCA) at the aortic cusp (AC) for the treatment of supraventricular tachyarrhythmia (SVT) has not yet been studied.Methods We performed RFCA at the AC in 19 patients (male 64.7%, 46.9±21.9 years old) with para-Hisian SVTs (12 atrial tachycardias [AT], 7 atrioventricular reciprocating tachycardia [AVRT]), and analyzed the prevalence, electrophysiologic findings, clinical outcome, and compilation risk. Results 1. Among 113 patients with AT, 13 patients had para-Hisian AT and 12 patients (8.8%, 53.4±19.8 years old, 58.3% female) underwent successful ablation from non-coronary cusp (NCC; n=10), right CC (RCC; n=1) or left CC (LCC; n=1) without complication (3.12.3 times RF delivery). During 19.79.8 months of follow-up, AT recurred in a patient with multiple foci. 2. Among 580 patients with AVRT, 27 patients had a para-Hisian bypass tract (BT; 4.7%), and 7 of them (1.1%, 2 pre-excitation syndrome, 5 concealed BT) were successfully ablated at NCC (n=2) or RCC (n=5) (7.07.1 times RF delivery). Among 5 patients with AVRT successfully ablated at RCC, one patient developed complete heart block 48 hours after procedure, and 2 patients recurred AVRT or delta-wave in ECG during 13.911.7 month follow-up.Conclusion Catheter ablation within NCC is an effective procedure to eliminate para-Hisian SVTs. However, RFCA on RCC has a risk of heart block sometimes.