Zero-fluoroscopy catheter ablation of focal atrial tachycardia from the noncoronary cusp

Figure 1. A – A 12-lead electrocardiogram showing normal sinus rhythm followed by the run of focal atrial tachycardia induced by a single extrastimulus. B – Three-dimensional electroanatomical mapping of the aortic root and both atria (30º left and right anterior oblique views). The decapolar diagnostic electrode (DE) is placed in the superior vena cava. The shadow of the DE depicts the previous location in the coronary sinus. The ablation electrode (AE) is placed in the aortic root (retrograde femoral arterial approach). Note the posterior relation of the ablation point (Abl) to far-field recording of the His bundle potential (His). C – Pre‑ablation cardiac magnetic resonance showing the aortic root at the level of the coronary ostia. The left coronary artery and right coronary artery can be seen. No abnormalities are present. D – Post-ablation late gadolinium enhancement cardiac magnetic resonance. An ablation lesion (arrow) can be seen in the noncoronary cusp