Cha Myung-Jin, Kim Jun, Park Yoon Jung, Cho Min Soo, Park Hyoung-Seob, Kwon Soonil, Lee Young Soo, Ahn Jinhee, Choi Hyung-Oh, Park Jong-Sung, Hwang YouMi, Choi Jin Hee, Hwang Ki-Won, Kim Yoo-Ri, Han Seongwook, Oh Seil, Nam Gi-Byoung, Choi Kee-Joon, Pak Hui-Nam
Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Korean Circ J. 2022 Jul;52(7):513-526. doi: 10.4070/kcj.2021.0388. Epub 2022 Apr 4.
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.
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).
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.
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.
射频消融治疗心房颤动（AF）后发现的源自非冠状动脉主动脉瓣叶（NCC）的房性心动过速（ATs）鲜有报道。本研究旨在调查AF消融期间检测到的NCC ATs的患病率和临床特征，并将其特征与无AF的新发NCC ATs进行比较。
从11家三级医院的多中心AF消融登记处回顾性分析连续接受AF射频导管消融的患者。将AF消融期间新检测到的NCC AT的临床和电生理特征与其对照者（无AF的新发NCC AT消融病例）进行比较。
在10178例AF病例中，包括1301例再次消融病例，肺静脉隔离（PVI）后发现8例（0.08%）NCC AT病例（首次消融中为0.07%，再次消融病例中为0.15%）。所有ATs均可自发或在未输注异丙肾上腺素的情况下通过程控心房刺激重复诱发。心动过速的P波形态特征因病例而异，大多数病例表现为1:1房室传导。PVI和NCC AT成功消融后的AF复发率为12.5%（8例中的1例）。心动过速周期长度短于17例源自NCC的新发ATs（303对378，p=0.012）。AT成功消融期间及之后未发生房室传导阻滞。
PVI后发现的罕见NCC ATs（AF消融病例中的0.08%），与新发NCC ATs表现出不同特征，当AT从前间隔广泛传导时，无论P波形态如何，均应怀疑。
