Atrial tachycardia originating from the left coronary cusp near the aorto–mitral junction: Anatomic considerations

Atrial tachycardias (ATs) have been successfully ablated from the noncoronary cusp (NCC) with minimal risk. 1 Ouyang F. Ma J. Ho S.Y. et al. Focal atrial tachycardia originating from the non-coronary aortic sinus: electrophysiological characteristics and catheter ablation. J Am Coll Cardiol. 2006; 48: 122-131 Abstract Full Text Full Text PDF PubMed Scopus (149) Google Scholar , 2 Rillig A. Meyerfeldt U. Birkemeyer R. et al. Catheter ablation within the sinus of Valsalva: a safe and effective approach for treatment of atrial and ventricular tachycardias. Heart Rhythm. 2008; 5: 1265-1272 Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar , 3 Kriatselis C. Roser M. Min T. et al. Ectopic atrial tachycardias with early activation at His site: radiofrequency ablation through a retrograde approach. Europace. 2008; 10: 698-704 Crossref PubMed Scopus (21) Google Scholar , 4 Das S. Neuzil P. Albert C.M. et al. Catheter ablation of peri-AV nodal atrial tachycardia from the noncoronary cusp of the aortic valve. J Cardiovasc Electrophysiol. 2008; 19: 231-237 Crossref PubMed Scopus (54) Google Scholar Large atrial electrograms are routinely recorded when mapping the NCC. Because atrial musculature has not been demonstrated to extend into the NCC, the likely substrate for atrial arrhythmia ablation in this region may be the adjacent right atrial (RA) or left atrial (LA) myocardium behind the thin aortic wall at the level of the sinotubular junction.