Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Prevalence and Characteristics of Atrial Tachycardia From Noncoronary Aortic Cusp During Atrial Fibrillation Catheter Ablation

  • Myung-Jin Cha (Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jun Kim (Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yoon Jung Park (Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Min Soo Cho (Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hyoung-Seob Park (Division of Cardiology, Department of Internal Medicine, Dongsan Hospital, Keimyung University School of Medicine) ;
  • Soonil Kwon (Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital) ;
  • Young Soo Lee (Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center) ;
  • Jinhee Ahn (Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital) ;
  • Hyung-Oh Choi (Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital) ;
  • Jong-Sung Park (Division of Cardiology, Department of Internal Medicine, Dong-A University Hospital) ;
  • YouMi Hwang (Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, ST. Vincent's Hospital) ;
  • Jin Hee Choi (Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital) ;
  • Ki-Won Hwang (Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital) ;
  • Yoo-Ri Kim (Division of Cardiology, Department of Internal Medicine, Dongguk University Ilsan Hospital) ;
  • Seongwook Han (Division of Cardiology, Department of Internal Medicine, Dongsan Hospital, Keimyung University School of Medicine) ;
  • Seil Oh (Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital) ;
  • Gi-Byoung Nam (Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kee-Joon Choi (Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hui-Nam Pak (Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine)
  • Received : 2021.11.24
  • Accepted : 2022.03.10
  • Published : 2022.07.01
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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.

Keywords

References

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