Electrophysiological Characteristics of Successful Ablation Sites at Non-Coronary Cusp to Eliminate Adenosine-Sensitive Atrial Tachycardia

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Radiofrequency (RF) ablation for adenosine-sensitive atrial tachycardia (AT) has a potential risk of atrioventricular block because it originates from the atrioventricular nodal (AVN) area. The present study aimed to determine whether this AT can be eliminated by RF ablation from the non-coronary cusp (NCC), and, if that's the case, to elucidate electrophysiological characteristics of successful ablation sites. Method: A total of 5 patients with adenosine-sensitive AT were examined. Results: One to six RF ablations targeting the earliest atrial activation of the AT at the AVN area failed to eliminate the AT. However, only one RF ablation from the NCC successfully cured the AT in all patients without affecting the AVN function. Local atrial activation at the successful ablation sites preceded the earliest atrial activation of the right atrium (RA) 0 msec in 4 patients and 13 msec in 1, and the local electrograms were rather duller and smaller than those of the earliest activation in the RA. During mean follow-up periods of 12 months, no patient had recurrence of the AT. Conclusion: Adenosine-sensitive AT was eliminated by RF ablation from the NCC without affecting the AVN function. The electrogram of the successful ablation site was not very early and sharp compared with those at the earliest atrial activation in the RA. Such anatomical approach of RF ablation was acceptable in adenosine-sensitive AT.