Combination of electrophysiological mapping, RFCA, and atrial appendectomy in a 5-year- old girl with tachycardia-induced cardiomyopathy: A case report

Abstract

Background: Atrial tachycardia (AT) originating from the left atrial appendage (LAA) is uncommon and the most difficult arrhythmia to eliminate. Herein, we present the case of a 5-year-old girl with tachycardia-induced cardiomyopathy (TCM) caused by ATs originating from the LAA who was successfully treated with a combination of electrophysiological mapping, radiofrequency catheter ablation (RFCA), and atrial appendectomy. The effectiveness and safety of this combination therapy were evaluated through a 1-month follow-up period. Case presentation: A 5-year-old female patient presented with cough for 3 days and syncope for 1 day. Surface echocardiography and 24-hour monitoring showed that the patient had persistent atrial tachycardia. Echocardiography revealed that the patient had an enlarged left ventricular diastolic dysfunction (46.1 mm) and reduced left ventricular ejection fraction (28.53%). The location of the lesion at the apex of the LAA was further confirmed by an electrophysiological study and RFCA. After RFCA, electrocardiographic monitoring showed a sinus rhythm with occasional paroxysmal atrial tachycardia. Finally, atrial appendectomy was performed, and the sinus rhythm returned to normal. Conclusions. The heart function of the child improved and sinus rhythm persisted, proving the safety and effectiveness of the combined therapy of electrophysiological mapping, RFCA, and atrial appendectomy on TCM caused by ATs originating from the LAA.