Comparison of strategies for catheter ablation of focal atrial tachycardia originating near the His bundle region

Background Recent studies have suggested that para-Hisian atrial tachycardia (AT) can be successfully ablated from the right atrium (RA), left atrium (LA), or noncoronary cusp (NCC) in the aorta; however, the best approach remains unclear. Objective This study aimed to compare different approaches to radiofrequency catheter ablation (RFCA) of para-Hisian AT. Methods We retrospectively analyzed 68 consecutive patients (49[72%] women; mean age 61 ± 13 years) treated with RFCA for this type of AT. Mapping of the RA (n = 68), LA (n = 21), and NCC (n = 52) was performed during AT to identify the earliest activation site and to apply RFCA. Results RFCA successfully terminated AT in the RA in 13 of 28 patients (46.4%), in the LA in 4 of 16 patients (25.0%), and in the NCC in 46 of 52 patients (88.5%) after 1 procedure ( P P P Conclusion Mapping and ablation in the NCC should be always considered in cases of AT originating from the His bundle region, regardless of the LAT.