Catheter ablation of atrial tachycardia via extracardiac access

A female patient with nonautomatic focal atrial tachycardia with paraHissian location of the focus and previously unsuccessful ablation attempt in the right atrium (RA) is presented. Electroanatomic mapping demonstrated sequential activation of the anteroseptal area of the RA, anteroseptal area of the left atrium and non-coronary sinus of Valsalva with minimal differences in local activation times. Because of perceived risk of conduction disturbances ablation was done in the non-coronary sinus with immediate termination of the tachycardia, subsequent non-inducibility and without any complications.