Histological examination of the right atrial appendage after failed catheter ablation for focal atrial tachycardia complicated by cardiogenic shock in a post‐partum patient

Abstract

A 26-year-old woman in her first pregnancy presented with persistent atrial tachycardia (AT). AT was resistant to medications, cardioversions, and the first attempt of catheter ablation. Two months after delivery she developed severe systolic dysfunction and circulatory collapse. Emergent catheter ablation was performed with the support of percutaneous cardiopulmonary bypass and intraaortic balloon pump. The AT originated in the apex of the right atrial appendage (RAA). Repeated attempts at ablation were unsuccessful, prompting surgical RAA resection, which terminated the tachycardia and improved the cardiac function. Histological examination of resected RAA provided insights into mechanism of resistance to catheter ablation.

Maternal focal atrial tachycardia during pregnancy: A systematic review

“…Postpartum arrhythmia resolution was common in our review, but not universal 16 . Persistent rapid focal AT leading to tachycardia‐induced cardiomyopathy after delivery has been reported in a patient with a failed catheter ablation attempt during pregnancy 34 …”

“…A literature flow diagram outlining the systematic review is depicted in Figure 6. In total, 28 articles that included 30 patients were retrieved 13‐40 . The primary search via PubMed yielded 564 articles and identified nine articles for review 16,22,24‐29,33 .…”

“…The first report of catheter ablation for focal AT in a pregnant patient was in 2004 from India 23 . In Table 3, only irrigated was listed if both nonirrigated and irrigated radiofrequency ablation catheters were used, as was the situation in two cases reported by Mizumaki et al 34 and UPMC.…”

“…There have been nine patients with successful ablation for focal AT with zero fluoroscopy, including the case report presented in this manuscript 26,27,32,37‐39 . The one failed ablation attempt occurred in a patient where the focus was ultimately determined to be a diverticulum within the right atrial appendage 34 . Cure was achieved after surgical excision.…”

Cryoablation of distal right atrial appendage tachycardia focus using intracardiac echocardiography and no fluoroscopy: Improved outcomes with modern technology

“…Reports of incessant RAA tachycardia with tachycardia-induced cardiomyopathy in pregnant women represent cases that could be conducted with a fluoroless technique without delay and exposure of the patient and unborn child to antiarrhythmic medications. 10 , 11 In difficult cases such as the patient reported here, a multimodality approach can improve procedural outcomes and optimize patient safety.…”