Radio-frequency catheter ablation of atypical atrioventricular nodal reentrant tachycardia from a trans-aortic approach.

Radio-frequency catheter ablation (RFCA) was introduced for the treatment of reentrant tachyarrhythmias and has proven its usefulness, efficacy, and safety. It has gained the position of an early stage treatment option rather than being a 'last resort' option for certain groups of patients with supraventricular tachycardias including atrioventricular nodal reentrant tachycardia (AVNRT). The RFCA technique for AVNRT seems to have become established throughout these years and the right-side approach is considered to be the conventional method. However, in one percent of the patients with AVNRT it has been reported that they cannot be cured by the conventional method and a left-sided approach has been recommended. We experienced a case which presented with a fast/slow atypical AVNRT. We ultimately successfully treated the case with a left-sided (trans-aortic) RFCA approach. We believe the trans-aortic RFCA approach is a necessary alternative in the case of an unsuccessful RFCA via the right-sided approach even though the frequency of its need is very low.