Key result
Radiofrequency ablation using a retrograde transaortic/transmitral approach successfully terminated adenosine-sensitive atrial tachycardia originating near the apex of Koch's triangle.
Why the study?
Does a retrograde transaortic/transmitral approach allow successful radiofrequency ablation of adenosine-sensitive atrial tachycardia arising near the apex of Koch's triangle?
Case Report (n=1)
No
Does a retrograde transaortic/transmitral approach allow successful radiofrequency ablation of adenosine-sensitive atrial tachycardia arising near the apex of Koch's triangle?
A retrograde transaortic/transmitral approach is a feasible alternative for radiofrequency ablation of adenosine-sensitive atrial tachycardia originating from the apex of Koch's triangle when right-sided and noncoronary sinus approaches fail.
Answers are grounded in this paper and cite their sources.
May support retrograde approach as bailout option; leaves open need for prospective validation before wider use.
Atrial tachycardias (ATs) are relatively uncommon and their mechanisms include reentry or may be focal. The characteristics and radiofrequency (RF) ablation of adenosine-sensitive AT arising near the apex of Koch's triangle have been reported. We report a case of successful RF ablation of this tachycardia by using a retrograde transaortic/transmitral approach. An electrophysiological study performed during sinus rhythm showed continuous anterograde atrioventricular nodal and no ventriculoatrial conduction. The tachycardia could be induced and terminated by atrial extrastimulation and rapid atrial pacing. Although inverse resetting response pattern was observed, tachycardia termination by intravenous low-dose adenosine was rather suggestive of triggered activity as the mechanism. The earliest atrial activation was recorded in the His-bundle region. After ineffective right-sided attempts and failure to find earlier atrial activity during mapping the noncoronary sinus of Valsalva, this tachycardia was successfully ablated from the left atrial septum by using a retrograde transaortic/transmitral approach. This report demonstrates the feasibility of a novel retrograde left atrial approach for RF ablation of adenosine-sensitive AT originating from the apex of Koch's triangle.
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Hluchý et al. (2019) conducted a case report in Adenosine-sensitive atrial tachycardia (n=1). Radiofrequency ablation via retrograde transaortic/transmitral approach was evaluated on Tachycardia termination and non-inducibility. Radiofrequency ablation using a retrograde transaortic/transmitral approach successfully terminated adenosine-sensitive atrial tachycardia originating near the apex of Koch's triangle.
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