ASEAN Heart Journal

Intended for healthcare professional

Original Paper

ASEAN Heart Journal

September 2013, 21:1

First online: 05 September 2013

Original Paper

Ablation within the Aortic Sinus of Valsalva for the Treatment of Ventricular Arrhythmias Using a Standard Electrophysiology and Ablation System

Dinh Phong Phan MD,1 Tran Linh Pham MD,2 Quoc Khanh Pham MD, PhD,2 Lan Viet Nguyen , MD, PhD2
Open Access
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  • Summary
  • Supplementary Material
  • References
  • About this Article



Ablation within the aortic sinus of Valsalva for ventricular tachycardia (VT)/ premature ventricular complexes (PVCs) has been reported in only small patient cohorts. Limited data exists concerning the outcome and safety of aortic ablation.


The aim was to study the preliminary result and safety of catheter ablation for VT/PVCs originating from the aortic cusps.‚Äč


The study consisted of 49 consecutive patients with symptomatic VT/PVCs who underwent radiofrequency catheter ablation within aortic sinus cusps from January 2010 to April 2012. All the procedures were performed with conventional EP and ablation system. Aortic root angiography was used to define coronary cusp and catheter position. The ablation target sites were defined by pace mapping and early activation mapping techniques. Ablation parameters including tissue temperature and tissue impedance were also measured. Ablation success and recurrence was defined by ECG and clinical follow up and 24-hour Holter monitoring after 3 months. All the procedure-related complications were documented.


Of the 49 patients (24 men and 25 women, mean age 51.1 ¬Ī 13.7 years), the site of origin was the left coronary cusp (LCC) in 36 (73.4%), the right coronary cusp (RCC) in 5 (10.2%), the noncoronary cusp (NCC) in 2 (4.1%), and at the junction between the LCC and RCC (L-RCC) in 6 (12.3%) cases. The initial success rate was 93.9% (46/49). After a mean follow-up period of 12.5 ¬Ī 6.6 months, 41/49 (83.7%) were free of VT/PVCs without antiarrhythmic drugs. No severe complications (MI, strokes, aortic valve perforation‚Ķ) have been documented.


Ablation within the aortic sinus of Valsalva is safe and effective for the treatment of ventricular arrhythmias.


Public Health-Management Strategy Percutaneous Coronary Intervention Stent Dislodgement Stent Embolization

Open Access: This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.


Supplementary Material



1. Rillig A, Meyerfeldt U, Birkemeyer R, Jung W. Ablation within the sinus of Valsalva for treatment of supraventricular and ventricular tachycardias: what is known so far? Europace 2009 Sep;11(9):1142-50. PubMed  CrossRef

2.¬†Yamada T, McElderry HT, Doppalapudi H, Murakami Y, Yoshida Y, Yoshida N et al.¬†Idiopathic ventricular arrhythmias originating from the aortic root prevalence, electrocardiographic and electrophysiologic characteristics, and results of radiofrequency catheter ablation.¬†J Am Coll Cardiol¬†2008;52:139‚Äď47.¬†PubMed¬†¬†CrossRef

3.¬†Kanagaratnam L, Tomassoni G, Schweikert R, Pavia S, Bash D, Beheiry S et al.¬†Ventricular tachycardias arising from the aortic sinus of Valsalva: an under-recognized variant of left outflow tract ventricular tachycardia.¬†J Am Coll Cardiol¬†2001; 37:1408‚Äď14.¬†PubMed¬†¬†CrossRef

4.¬†Rillig A, Meyerfeldt U, Birkemeyer R, Treusch F, Kunze M, Brasch M et al.¬†Catheter ablation within the sinus of Valsalva - a safe and effective approach for treatment of atrial and ventricular tachycardias.¬†Heart Rhythm¬†2008; 5:1265‚Äď72.¬†PubMed¬†¬†CrossRef

5.¬†Yamada T, Yoshida N, Murakami Y, Okada T, Muto M, Murohara T et al.¬†Electrocardiographic characteristics of ventricular arrhythmias originating from the junction of the left and right coronary sinuses of Valsalva in the aorta: the activation pattern as a rationale for the electrocardiographic characteristics.¬†Heart Rhythm¬†2008;5:184‚Äď92.¬†PubMed¬†¬†CrossRef

6.¬†Yamada T, Litovsky SH, Kay GN.¬†The left ventricular ostium: an anatomic concept relevant to idiopathic ventricular arrhythmias.¬†Circ Arrhythm Electrophysiol¬†2008;1: 396‚Äď404.¬†PubMed¬†¬†CrossRef

7.¬†Suleiman M, Asirvatham SJ. Ablation above the semilunar valves: when, why, and how? Part I [Review].¬†Heart Rhythm¬†2008;5:1485‚Äď92.¬†PubMed¬†¬†CrossRef

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9.¬†Ouyang F, Fotuhi P, Ho SY, et al.¬†Repetitive monomorphic ventricular tachycardia originating from the aortic sinus cusp: electrocardiographic characterization for guiding catheter ablation.¬†J Am Coll Cardiol¬†2002;39:500‚Äď8.¬†PubMed¬†¬†CrossRef

10.¬†Hachiya H, Aonuma K, Yamauchi Y, Igawa M, Nogami A, Iesaka Y.¬†How to diagnose, locate, and ablate coronary cusp ventricular tachycardia.¬†J Cardiovasc Electrophysiol¬†2002;13:551‚Äď6.¬†PubMed¬†¬†CrossRef

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About this Article


Stent Embolization in the Current Era of Percutaneous Coronary Intervention: a NUHCS Experience

Open Access

Available under Open Access


>> 21:2

Online Date

21 November 2019



Online ISSN



ASEAN Federation of Cardiology

Additional Links

>> About The AHJ




Public Health

Management Strategy

Percutaneous Coronary Intervention

Stent Dislodgement

Stent Embolization

Author Affiliations

1. Adult clinical and interventional cardiologist, Metropolitan Medical Centre, 1357 G, masangkay st, Sta Cruz, Manila, Philippines

2. Department of Cardiology, National University Heart Centre, Singapore, Singapore

Correspondence to:

Dinh Phong Phan