Potential anatomic substrate of peri-atrioventricular nodal atrial tachycardia ablated from the noncoronary sinus of Valsalva
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Although focal atrial tachycardia (AT) is known to sometimes be ablated from the noncoronary aortic cusp (NCC), the electro-anatomic characteristics of NCC-AT are not well known.
We compared the clinical, 12-lead electrocardiogram (ECG), and transthoracic echocardiogram characteristics of 6 women (median age, 66.5 years) with NCC-AT and 12 age-matched women (median age, 64.0 years) with atrioventricular nodal reentrant tachycardia (AVNRT) as the control group.
There was no difference in the prevalence of hypertension between the two groups (67 vs. 33 %, respectively, P = 0.3213). The resting ECG of the NCC-AT group vs. that of the AVNRT group showed a significantly longer PQ interval (170.0 (interquartile range (IQR), 157.5–180.0 ms) vs. 140.0 ms (IQR, 122.5–147.5 ms), P = 0.0010) and leftward shifting of the QRS axis (4° (IQR, −26.0° to 24.0°) vs. 57° (IQR, 43.0–70.2°), P = 0.0087). The upper interventricular septum (IVS) thickness was significantly greater (15.6 (IQR, 11.9–18.7 ms) vs. 11.7 mm (IQR, 10.2–12.9 ms), P = 0.0393), and the angle formed by the aortic roof and IVS (AS angle) was significantly steeper (103.0° (IQR, 94.2–119.2°) vs. 122.5° (IQR, 108.5–128.5°), P = 0.0343) in the NCC-AT group than in the AVNRT group.
Our data suggest that NCC-AT is characterized by a longer atrioventricular (AV) conduction time, steeper AS angle, and thicker IVS than are seen with AVNRT. These electrocardiographic and echocardiographic characteristics from the IVS to the peri-AV nodal regions may have some effect on the development of NCC-AT.
KeywordsAtrial tachycardia Noncoronary aortic cusp Electrocardiography Echocardiography
Funding of this study includes departmental resources only.
Conflict of interest
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