Atrial tachycardias arising from the atrial appendages and aortic sinus of valsalva

Emergent Zero-Fluoroscopy Mapping and Thoracoscopic Ectomy of Appendage in Pregnant Women with Life-Threatening Atrial Tachycardia: A Case Report and Literature Review

Background: Focal atrial tachycardia (AT) originating from the right atrial appendage (RAA), often persistent and refractory, is clinically rare in pregnant woman, and the therapy is much more challenging. We report that a pregnant woman presented with hypotension due to persistent and refractory atrial tachycardia and was successfully cured by a multidisciplinary treatment (MDT) approach, consisting of a combination of zero-fluoroscopy mapping and thoracoscopic atrial appendectomy. We also carried out a literature review of this topic. Methods and Results: A 26-year-old woman in pregnancy at 21 weeks presented with severe palpitation and hypotension due to persistent rapid supraventricular tachycardia (SVT). Since adenosine triphosphate could not terminate the tachycardia, a catheter ablation procedure was planned and finally canceled when the zero-fluoroscopy mapping using Carto 3^TM system revealed an atrial tachycardia originating from the RAA. Thoracoscopic RAA ectomy was recommended after multidisciplinary consultation and successfully performed without fluoroscopy. Ensite^TM velocity mapping system was used for accurately locating the origin of the arrhythmia during ectomy. The woman finally produced a healthy baby during follow-up. Conclusions: Focal AT originating from appendage in pregnant patients can be persistent, refractory, and life-threatening; traditional strategies, such as medicine or catheter ablation, are limited in this situation. MDT measures, using a thoracoscopic ectomy and zero-fluoroscopy three-dimensional electroanatomical mapping technique, is minimally invasive and a promising strategy.

Surgical treatment of a difficult case of atrial tachycardia requiring multiple electrophysiologic procedures

A 34-year-old male with incessant drug-refractory atrial tachycardia (AT) was referred to our clinic for catheter ablation. The procedure began with endocardial activation mapping. The earliest endocardial activation site was in the right atrial appendage (RAA). The procedure continued with mapping of the left atrium through a transseptal approach. The earliest local activation was recorded at the anterior site of the right pulmonary veins. Radiofrequency (RF) ablation of both localizations was performed synchronously but failed to terminate the arrhythmia. The procedure continued with isolation of the RAA using cryoballoon but failed again due to the anomalous structure of the RAA. Then, epicardial RF ablation was attempted but failed. Finally, AT could only be terminated by surgical excision of the RAA.

Right atrial appendage tachycardia: A rare cause of tachycardia induced cardiomyopathy in a 4-year-old child

We present a rare case of tachycardiomyopathy in a 4-year-old girl. The child had incessant atrial tachycardia (AT) and refractory heart failure. Right atrial appendage (RAA) was localised as the source of the ectopic tachycardia. The child underwent successful radiofrequency ablation (RFA) using 3-D electroanatomical mapping. Fluoroscopy was used sparingly only to rule out underlying anomalies. The left ventricular functions returned to normal by one month after the procedure. RAA AT is rare in very young children and usually necessitates surgical appendectomies. RFA is a challenge in such age groups and there are very few published literature on RAA AT in very young children.