BACKGROUND Catheter ablation of ventricular arrhythmias (VAs) originating from the para-Hisian region could be challenging because of a potential damage to atrioventricular conduction system. OBJECTIVE The purpose of this study was to evaluate the safety and efficacy of catheter ablation of VAs originating from the para-Hisian region via a systematic direct approach from aortic sinus cusps (ASCs). METHODS Twenty-one consecutive patients with VAs with para-Hisian origin were included. Electrophysiological mapping of the entire right ventricle was initially performed, and then retrograde ASC mapping was performed when the earliest ventricular activation was recorded in the His bundle region. Ablation was preferentially performed within ASCs in all patients. RESULTS Radiofrequency energy delivery resulted in the elimination of VAs in 17 of 21 patients (81%). In the remaining 4 patients, radiofrequency application was initiated at the target site of the right ventricular septum around the His bundle region and clinical VAs were finally successfully eliminated without junctional rhythm in 2 of 4 patients. During a mean follow-up of 34.8 +/- 11.3 months, 1 of the 19 acute successful patients had VA recurrence. No procedure-related complications occurred during ablation or follow-up. CONCLUSION Catheter ablation of VAs originating from the para-Hisian region via a direct approach from ASCs may be safe and effective in most unselected patients.