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

BACKGROUND: 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. OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.