Incessant Atrial Tachycardia: Problem Solving With Minimally Invasive Surgery

Abstract

A 35-year-old female with sarcoidosis sought medical attention due to palpitations. The ECG showed an atrial tachycardia (AT), apparently originating in the left atrium. A 24-hour Holter monitoring revealed AT to be present during the entire day. Cardiac magnetic resonance exhibited no cardiac involvement by sarcoidosis but registered a mildly depressed left ventricular ejection fraction (LVEF). Atrial electroanatomical mapping showed the earliest activation zone on the distal portion of the left atrial appendage (LAA). Considering the high risk for perforation with catheter ablation in this region, she was sent to thoracoscopic surgical LAA exclusion with a clip device; it was possible to witness the termination of the arrhythmia during the procedure. She was safely discharged two days after surgery and has completed a one-year follow-up without recurrence of AT or symptoms, and with normalization of LVEF.

Incessant Atrial Tachycardia From the Left Atrial Appendage Treated With Appendage Ligation

“…Clipping of the appendage to treat a focal tachycardia has been reported only once before in the literature. 11 The present case illustrates both the importance of prompt recognition and management of impending cardiogenic shock from tachycardia mediated cardiomyopathy and the use of pharmacologic, ablative, and surgical techniques in managing difficult-to-treat arrhythmias.…”