Aortic root-based ablation of para-Hisian atrial tachycardia: Acute and long-term outcomes from a consecutive series

Ablation of focal para-Hisian atrial tachycardia (PHAT) carries a risk of atrioventricular block owing to its proximity to the conduction system. A retroaortic radiofrequency approach from the noncoronary cusp (NCC) has emerged as a safe and effective alternative to right atrial ablation.

This study aimed to evaluate the acute success and complication profile of a preferential aortic root-based mapping and ablation strategy for PHAT and compare arrhythmia-free survival after PHAT ablation with that of focal atrial tachycardias (FATs) from other locations.

We analyzed 167 consecutive FAT ablation procedures performed between 2014 and 2024, including 31 PHAT cases, in a center where the retroaortic approach is the preferred strategy for PHAT ablation.

Among the 167 FATs, 31 (18.5%) were ablated initially from the NCC. Patients with PHAT were older than those with other FAT origins (71.5 ± 12.8 vs 59.6 ± 18.5 years; P < .001). Acute success was achieved in all cases. 2 patients ablated from the NCC required right atrial applications for acute success. Complications occurred in 2 of 31 cases: 1 mild PR prolongation during aortic root ablation and 1 femoral pseudoaneurysm. At the 36-month follow-up, there was a nonsignificant trend toward a higher recurrence rate in the non-PHAT group (hazard ratio 0.45; 95% confidence interval 0.18-1.14; P = .08).

A preferential NCC approach for the ablation of PHAT seems to be safe and is associated with favorable outcomes compared with other FATs, supporting its consideration as a first-line strategy.