Successful ablation of aortic cusp tachycardia from right ventricle outflow tract using a superior approach

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Idiopathic ventricular tachycardia (VT) originating from the aortic cusp can be challenging to ablate due to proximity to coronary ostia.
• Conventional endocardial approaches may provide suboptimal mapping and ablation targets in these cases.

Observation:

• A case of idiopathic aortic cusp tachycardia near the right coronary artery ostium was identified.
• Standard transfemoral endocardial mapping from the right ventricular outflow tract (RVOT) yielded suboptimal results for tachycardia localization.
• Retrograde aortic mapping pinpointed the VT origin to the right coronary sinus.

Findings:

• An unconventional superior approach via the jugular vein was employed for radiofrequency catheter ablation.
• Successful ablation of the idiopathic aortic cusp tachycardia was achieved using this alternative route.
• The patient remained free of VT recurrence during an 18-month follow-up period.

Implications:

• This case demonstrates the feasibility and safety of a superior approach for ablating VT originating near the right coronary ostium.
• It highlights the importance of considering alternative access routes when conventional methods are suboptimal.
• This technique may offer a valuable option for managing challenging cases of aortic cusp VT.