Pulsed-Field Ablation of Atrial Tachycardia Arising From the Noncoronary Sinus of Valsalva

BACKGROUND: Pulsed-field (PF) ablation of atrial tachycardia (AT) originating from noncoronary sinus (NCS) of Valsalva has not been reported. Related concerns include coronary spasm, conduction damage, and effective lesion formation despite successful animal study. CASE SUMMARY: A 72-year-old man with recurrent AT after radiofrequency ablation of paroxysmal atrial fibrillation underwent repeated ablation using a focal PF catheter. AT was repeatedly induced and confirmed to be arising from the bottom of the NCS, where a single train (1,800 V/5 trains per PF application) terminated the AT and rendered it noninducible. No coronary spasm, P-R prolongation, or aortic valve dysfunction was documented after 3 PF applications. The patient remained arrhythmia free at 1-month follow-up. DISCUSSION: This case suggests that PF ablation of NCS-AT is feasible and safe. The promising acute and 1-month results warrant further validation in larger studies with long-term follow-up. TAKE-HOME MESSAGES: Similar to radiofrequency, PF ablation from the bottom of the NCS was effective and safe to treat NCS-AT, with no evidence of coronary artery spasm, damage to the aortic valve, or exacerbation of pre-existing conduction system disease. These encouraging initial results warrant further validation in studies with larger sample sizes and longer follow-up to establish the safety and effectiveness of PF ablation for NCS-AT.