Article

Atrial tachycardia originating from the left coronary cusp near the aorto-mitral junction: Anatomic considerations

Heart Rhythm Center, the Heart Institute, Cedars-Sinai Health System, Los Angeles, California 90048, USA.
Heart rhythm: the official journal of the Heart Rhythm Society (Impact Factor: 5.08). 03/2010; 7(7):987-91. DOI: 10.1016/j.hrthm.2010.03.017
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Available from: Tong Liu, Jan 05, 2014
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    • "In our case, the P waves were not as narrow as those of AT originating from the His-bundle region. This finding was consistently observed in the cases reported by Shehata, et al.9 and might be caused by a more left-sided location than an HB-region tachycardia. "
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    ABSTRACT: Atrial tachycardia (AT) originating from the aortomitral junction is a very rare and challenging disease. Its arrhythmic characteristics have not been described in detail compared with the descriptions of the arrhythmic characteristics of AT originating from the other locations. Only a few case reports have documented successful ablation of this type of AT using transaortic or transseptal approaches. We describe a case with AT that was resistant to right-sided ablation near the His bundle failed and transaortic ablation at the aortomitral junction successfully eliminated.
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    • "In this case, RF energy delivered from the NCC temporarily terminated the AT with a variable cycle length, and may have been located in close proximity to the AT focus in that area. As an anatomical consideration, the right atrial myocardium behind the NCC extends from the His-bundle region to a superior site of the tendon of Todaro, which is slightly anterior to the interatrial septum[8]. This AT is likely to have originated from the mitral annulus– aorta junction (M–Ao junction)[4]. "
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    ABSTRACT: Here we report a case of adenosine-sensitive focal atrial tachycardia that was successfully ablated from the left atrium at a site located adjacent to the posterior site of the left coronary cusp in spite of failed ablations from the superior-septal right atrium and non-coronary aortic cusp. In the case of an unsuccessful ablation from the right superoseptum and non-coronary aortic sinus, the left atrial septum represents a potential optional site for ablation. © 2013 Japanese Heart Rhythm Society. Published by Elsevier B.V. All rights reserved.
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