We report a rare case of double outlet atrial tachycardia (DOAT) originating from the ascending aorta in an 84-year-old male with drug-refractory palpitations. Electrophysiologic study revealed dual exit sites from the non-coronary cusp and adjacent right atrium with alternating P-wave morphologies. Initial ablation attempts at conventional sites were unsuccessful. Activation mapping identified the earliest signal in the ascending aorta, where radiofrequency ablation terminated tachycardia without recurrence.