Abstract
Purpose: Atrial tachycardias (AT), antidromic reciprocating tachycardias and orthodromic reciprocating tachycardias (ORT) with parahisian origin are not uncommon. Catheter ablation at this area posed significant risk of heart block. Ablation at non- coronary cusp (NCC) was proposed to be safe and effective. We sought to investigate electrophysiological characteristics and catheter ablation in this area with various types of arrhythmia. Method: This study included 8 patients with focal AT, 4 patients with Wolff Parkinson White Syndrome (WPW) and 4 patients with concealed orthodromic reciprocating tachycardia (ORT). Activation mapping was performed during tachycardia in all cases. In WPW without tachycardia or retrograde atrial conduction, mapping ventricular insertion during maximal pre-excitation was done. Aortogram was done in all cases in order to confirm catheter position. Echocardiogram was done after procedure to look for new onset aortic regurgitation. Result: Four cases of AT (50%) and 4 cases of ORT (100%) were incessant during procedure. All cases of WPW had atrial fibrillation before index procedure. Parahisian origin were confirmed in all cases by pacing manoeuvre. In AT group, activation mapping demonstrated an earliest atrial activation preceded the atrial activation at the His Bundle by 18 ± 3 msec. All accessory pathway in WPW and ORT group were confirmed by parahisian pacing. Detailed mapping showed earliest atrial potential (ORT group) and ventricular potential (WPW group) during tachycardia was located superoposterior to His Bundle. During ablation in all cases, mapping was performed in aortic sinus and all cusps. Irrigation catheter was required to eliminate tachycardia in 8 cases. His potential were not found at the target ablation site. AT were terminated in all cases within 5 second and all accessory pathway was eliminated within 5 second. Neither junctional beats nor PR prolongation was found during ablation. No complication occurred. Post procedure echocardiography did not show new aortic regurgitation. All patients were arrhythmia free after 1 year follow up. Conclusion: In patient with AT, ORT or WPW near the His bundle, mapping in NCC is an viable option and catheter ablation is safe and effective.
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