Safety and efficacy of catheter ablation of ventricular arrhythmias with para-Hisian origin via a systematic direct approach from the aortic sinus cusp

Reentrant para‐Hisian ventricular tachycardia eliminated from the noncoronary cusp: Importance of regional anatomy for vantage‐point ablation

“…This case also highlights two important points: (a) successful ablation sites do not necessarily indicate the true site of origin (vantage point) and (b) ablation of para‐Hisian arrhythmias from the aortic root is likely safer than right‐sided ablation to prevent heart block. Ablation from the aortic root is a safer vantage point as the catheter position is shielded by the aortic leaflet superior to the penetrating His bundle 8,9 . To the best of our knowledge, only two cases of permanent heartblock have been reported after ablation from aortic root for septal accessory pathway and atrial tachycardia 10,11 Permanent heart block has not been reported in ablation for ventricular arrhythmias to date.…”

“…Ablation from the aortic root is a safer vantage point as the catheter position is shielded by the aortic leaflet superior to the penetrating His bundle. 8,9 To the best of our knowledge, only two cases of permanent heartblock have been reported after ablation from aortic root for septal accessory pathway and atrial tachycardia 10,11 Permanent heart block has not been reported in ablation for ventricular arrhythmias to date.…”

Catheter Ablation of Idiopathic Ventricular Arrhythmias Originating from the Para-Hisian area - QRS Morphology Change and Late Effect of the Ablation: Case Series

“…The myocardial network around the ventricular outflow tracts septum is complex, so a single VA focus with preferential conduction to multiple exit sites may result in different QRS morphologies after ablation. 14 Moreover, mapping and ablation in the right and non-coronary sinus of Valsalva may be needed for para-Hisian PVCs 3,5 , as it was shown in the third case where it was necessary to minimize the potential risk of injuring the proximal His bundle. However, acute success could not always be achieved safely, so it seemed better to stop the procedure and wait for a late effect of the ablation.…”

“…1 A few studies have demonstrated idiopathic VAs arising near the His bundle, which represented 3-9% of all idiopathic Vas. [2][3][4][5] Ablation in this highly com-plex region could be challenging due to the potential risk of damage to the conduction system of the heart. 6 The aim of this study was to show the relatively uncommon phenomenon of shift of the exit site and corresponding change of the QRS morphology during catheter ablation (CA), different CA approaches and short-and long-term results of radiofrequency (RF) CA of para-Hisian VAs.…”

Strategy of catheter ablation for para‐Hisian premature ventricular contractions with the assistance of remote magnetic navigation

“…In this study, for one patient who had experienced failure of ablation in both the RV and LV septa, we attempted ASC mapping via the right femoral artery, but no ablation was performed, as an optimal site could not be selected. Wei et al 14 also reported that PH-PVCs that had anatomical locations inferior to the His bundle showed less success when ablating from the ASC. This was possibly due to a greater distance between ASC and the origin of the VAs.…”