Porto AG, Zappulla P, Conti S, Sgarito G. When the atrium is not enough, ablation of anteroseptal focal atrial tachycardia from the non-coronary aortic cusp: A case report. World J Clin Cases 2026; 14(14): 120147 [DOI: 10.12998/wjcc.v14.i14.120147]
Corresponding Author of This Article
Sergio Conti, MD, PhD, FHRS, FESC, Assistant Professor, Division of Cardiology, Department of Internal Medicine, Section of Cardiac Electrophysiology, University of Iowa Health Care Center, 200 Hawkins Dr, Iowa, IA 52242, United States. sergioconti.md@gmail.com
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Cardiac & Cardiovascular Systems
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Case Report
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May 16, 2026 (publication date) through Apr 27, 2026
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World Journal of Clinical Cases
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Porto AG, Zappulla P, Conti S, Sgarito G. When the atrium is not enough, ablation of anteroseptal focal atrial tachycardia from the non-coronary aortic cusp: A case report. World J Clin Cases 2026; 14(14): 120147 [DOI: 10.12998/wjcc.v14.i14.120147]
World J Clin Cases. May 16, 2026; 14(14): 120147 Published online May 16, 2026. doi: 10.12998/wjcc.v14.i14.120147
When the atrium is not enough, ablation of anteroseptal focal atrial tachycardia from the non-coronary aortic cusp: A case report
Andrea Giuseppe Porto, Paolo Zappulla, Sergio Conti, Giuseppe Sgarito
Andrea Giuseppe Porto, Division of Cardiology, Cannizzaro Hospital, Catania 95021, Sicilia, Italy
Paolo Zappulla, Division of Cardiology, University Hospital a Policlinico “G.Rodolico-San Marco”, Catania 95123, Italy
Sergio Conti, Division of Cardiology, Department of Internal Medicine, Section of Cardiac Electrophysiology, University of Iowa Health Care Center, Iowa, IA 52242, United States
Giuseppe Sgarito, Department of Cardiac Electrophysiology, IRCCS ISMETT-UPMC Heart Center, Institute for Transplantation and Advanced Specialized Therapies, Palermo 90127, Italy
Author contributions: Porto AG and Sgarito G contributed to conceptualization; Porto AG and Zappulla P contributed to methodology and investigation; Porto AG contributed to writing, original draft preparation; Conti S and Sgarito G contributed to writing-review and editing.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Sergio Conti, MD, PhD, FHRS, FESC, Assistant Professor, Division of Cardiology, Department of Internal Medicine, Section of Cardiac Electrophysiology, University of Iowa Health Care Center, 200 Hawkins Dr, Iowa, IA 52242, United States. sergioconti.md@gmail.com
Received: February 24, 2026 Revised: March 9, 2026 Accepted: March 31, 2026 Published online: May 16, 2026 Processing time: 70 Days and 3.4 Hours
Abstract
BACKGROUND
Adenosine-sensitive focal atrial tachycardias (AT) arising from the anteroseptal region are uncommon and may be difficult to ablate safely because of their proximity to the atrioventricular (AV) conduction system. Failure of conventional right or left atrial ablation should prompt consideration of alternative anatomical sites.
CASE SUMMARY
A 64-year-old caucasian man with no structural heart disease presented with recurrent adenosine-sensitive supraventricular tachycardia. Electrophysiological study demonstrated a long-RP focal AT with intermittent AV block and earliest activation in the anteroseptal right atrium. High-density mapping and radiofrequency (RF) applications in both atria were ineffective. Mapping of the aortic root identified the earliest atrial signal in the non-coronary cusp, 36 milliseconds before the surface P wave, with a negative unipolar electrogram. RF delivery at this site terminated the tachycardia, and additional consolidation lesions prevented recurrence. The arrhythmia was no longer inducible under isoproterenol. At 3-year follow-up, the patient remains asymptomatic without antiarrhythmic therapy.
CONCLUSION
The non-coronary cusp is a safe and effective ablation target for anteroseptal focal atrial tachycardia.
Core Tip: Anteroseptal focal atrial tachycardia may originate from tissue adjacent to or within the aortic root. When right and left atrial ablation is ineffective or hazardous, systematic mapping of the non coronary cusp can provide a safe and durable cure while minimizing the risk of atrioventricular block.
