TEE-guided ablation of the anteroseptal accessory pathway from the noncoronary cusp of the aortic valve: A novel application of 3-dimensional images

Prevalence, risk, and benefits of radiofrequency catheter ablation at the aortic cusp for the treatment of mid to anteroseptal supra-ventricular tachyarrhythmias

“…Among our patients, 2 out of 12 patients were incidentally found with AC originated AT during AF catheter ablation, and their incidence was 0.6% (2/320). In terms of bypass tract ablation at the AC, there have been several case reports [11][12][13][14][15], but our study might be the first to systemically conducted study for catheter ablation of mid-to anteroseptal AVRT at the AC.…”

“…An aortic cusp (AC) is one of embryologic raphe structures and an excellent target for catheter ablation of some VTs originating from the left ventricular outflow tract (LVOT) because it allows good contact and stable position of the catheter [7,8]. However, radiofrequency catheter ablation (RFCA) of supraventricular tachyarrhythmias (SVTs) is rarely performed at the AC in patients with atrial tachycardia (AT) [9,10] or atrioventricular reciprocating tachycardia (AVRT) [11][12][13][14][15]. Recently, it was reported that aortographically determined anatomical position of AC and their electrogram pattern lead to safe and effective catheter ablation [16].…”

Selective Angiography Using the Radiofrequency Catheter: An Alternative Technique for Mapping and Ablation in the Aortic Cusps

“…Alternative image tests have also been proposed to avoid risks due to coronary angiography (i.e., vascular injury from a second arterial access or coronary dissection). Transesophageal echocardiography has been proposed as an alternative, but only single case reports have been published . More recently, Hoffmayer et al .…”

“…Transesophageal echocardiography has been proposed as an alternative, but only single case reports have been published. 17,18 More recently, Hoffmayer et al 15 published a large case series of coronary cusp ablation using ICE, that allows to assess real time distance between catheter tip and coronary ostia and could also help indirectly in assessing contact of the catheter with cusp wall. On the other hand, in this paper almost 10% of the patients also required additional CA to confirm catheter tip distance to the coronary artery.…”

Radiofrequency ablation of anteroseptal accessory pathway: A challenge to the electrophysiologist

“…The left side of the anteroseptal region is a membranous structure and defined by the aortic annulus and NCC is directly related to the septum. Location and dynamic motion of the NCC leads to difficulties of access as well as keeping a stable position of the catheter, so in one case, transesophageal echocardiogram was used for assistance 9 . However, intracardiac echocardiography could be a better and more advantageous tool for precise imaging of anatomical structures and guide to successfully manage the position of the catheter tip at NCC of the aortic valve 10 .…”