The Clinical Analysis Of Radiofrequency Catheter Ablation Tachycardia Originating From The Aortic Sinus

Background: Percutaneous endocardial catheter ablationtachycardia had become the primary treatment of choice in patients withtachycardia including paroxysmal supraventricular tachycardia(atrioventricular nodal reentrant tachycardia and atrioventricular reentranttachycardia), atrial tachycardia (AT), idiopathic ventricular tachycardia(VT) or premature ventricular contractions (PVCs), typical atrial flutteretc. That has high success rate (＞98%) in 20 years recently. It has alsoobtained to ablate atrial fibrillation in recent year. But a few patientscould not be ablated through endocardial approach as a result of cardiacanatomic constraint, which needed epicardial accesses to ablatesuccessfully from the aortic sinus of Valsalva, the coronary sinus or viatranspericardial etc. Lately literatures reported catheter ablation from theaortic sinus cusp could heal tachycardia in patients with ventricularVT/PVCs, anteroseptal focal AT, anteroseptal accessory pathway (AP)etc, which failed via endocardial approach.Objectives: We sought to discuss the electrophysiologicalcharacteristics guiding catheter ablation tachycardia originating from theaortic sinus cusp in patients with VT/PVCs, anteroseptal focal AT,anteroseptal AP etc, and to summarize the validity and security of theapproach. Methoeds: Routine 12-lead surface electrocardiography andelectrophysiological characteristics, the ablation target sites reviewanalysis were performed on 17 tachycardia patients which successfullyeliminated from aortic sinus cusp with no organic heart disease, including12 VT/PVCs, 3 ATs and 2 APs. The left main coronary artery wascannulated as a marker and to protect during radiofrequency delivery, todescribe the relationship between the ablation catheter and coronal arterysinus, and to summarize and follow-up the validity and security.Results: Among analyzed 17 cases, there were 12 cases of VT/PVCs (10 cases originating from the left aortic sinus, 2 cases from theright aortic sinus). The surface ECG analysis revealed rs, rS or QS waveon leadâ… and aVL, large R wave on leadâ…¡,â…¢and aVF, Precordial Rwave transition occurred on lead V₂ or V₃, the indexes of R/S waveamplitude≥30% in lead V₁, the average of R wave duration was82.2±16.4ms, the indexes of R/QRS wave duration≥50%, large R waveon lead V₅ and V₆ but no s wave either lead V₅ or V₆. The earliestventricular electrogram at a successful ablation site was recorded35.2±21.6ms before QRS onset.3 patients with focal anteroseptal AT were reproducibly induced andterminated by atrial pacing, the surface ECG characteristics: theinterphase of P' wave during AT was obviously narrower than that of Pwave during sinus rhythm, the P' wave was positive in leadâ… and aVL, which was negative/positive in leadâ…¡,â…¢and aVF, mapping in atriademonstrated that the earliest atrial activation was located at the Hisregion, whereas mapping in the non-coronary aortic sinus demonstratedthat an earliest atrial activation preceded the atrial activation at the Hisregion by 12.3±7.8ms and was anatomically located superoposterior tothe His region in all 3 patients. Also the His potentials were not found atthe successful site in the non-coronary aortic sinus in all 3 patients.The routine 12-lead surface ECG of 2 cases with anteroseptal APrevealed narrow QRS complex during sinus rhythm with no prexcitationwave and narrow QRS complex tachycardia, the earliest atrial activationwere recorded in the non-coronary aortic sinus with no His potential.17 patients were successfully abolished, the operating time was103.4±24.7(65～120) minutes and the X-ray exposure time was24.8±13.9(12～30) minutes. All 17 patients were free of arrhythmiaswithout antiarrhythmic drugs during a follow-up of 15.2±12.1(2～40)months.Conclusions: The specific surface ECG and electrophysiologicalcharacteristics of VT/PVCs, anteroseptal focal AT, anteroseptal APoriginating from the aortic sinus cusp are helpful for guildingradiofrequency ablation when the tarchycardia was failed to ablate at theroutine endocardium approach. A few tachycardia can be abolishedsuccessfully and safely.