Catheter ablation of tachyarrhythmias from the aortic sinuses of Valsalva--when and how?

The aortic root is at the center of the heart. Each of the aortic sinuses of Valsalva, positioned at the base of the aortic root, is in contact with the atrial myocardium and/or ventricular myocardium at their bases, which enables mapping and ablating of some ventricular arrhythmias with an outflow tract origin and supraventricular tachycardias (ie, atrial tachycardia, accessory pathways) from the aortic sinuses of Valsalva. These arrhythmias have characteristic electrocardiographic findings associated with their origins, and almost all are difficult to ablate from an atrial or ventricular endocardial site. Site-specific and potential complications, such as a coronary artery occlusion or atrioventricular block, can occur with catheter ablation at the aortic sinuses of Valsalva. Therefore, accurate diagnosis and proper ablation at the aortic sinuses of Valsalva are required for a cure. This review describes the anatomic features of the aortic sinuses of Valsalva and focuses on the diagnosis and radiofrequency catheter ablation of arrhythmias that can be ablated from this site. (Circ J 2012; 76: 791-800).