Percutaneous Pericardial Instrumentation for Catheter Ablation of Focal Atrial Tachycardias Arising from the Left Atrial Appendage

Abstract

Focal atrial tachycardias originating from the left atrial appendage present unique anatomic challenges for successful ablation. We describe the role of minimally invasive percutaneous epicardial mapping and ablation in the management of two patients with ectopic atrial tachycardias arising from the left atrial appendage following failure of a conventional endocardial approach to achieve cure.

Epicardial Ablation of Focal Atrial Tachycardia Arising From Left Atrial Appendage in Children

“…To the best of our knowledge, this is the first report on two children illustrating a FLAT with an epicardial LAA origin that was successfully ablated through percutaneous epicardial approach. Although, previously few cases have been reported with similar approach in adults and adolescents [7,8] , none have been reported in children. Catheter ablation using an epicardial access by a pericardial puncture may be necessary and is a proven feasible route for the management of a variety of arrhythmias especially the ventricular tachycardias [9].…”

Electrophysiologic Characteristics and Topographic Distribution of Focal Atrial Tachycardias in Dogs

“…8 FAT present a characteristic anatomic distribution with typical clustering around the crista terminalis (21%), the coronary sinus (CS) ostium and body (10%), the para-hissian region (5%), the tricuspid annulus (13-22%), the mitral annulus (28-36%), the pulmonary veins (PVs) (24%), the right interatrial septum (0.8%), the left interatrial septum (2%), and less commonly around the right and left appendages, the superior vena cava and the noncoronary aortic cusp. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Four to 17% of patients with FATs presented 41 focus, and with the most common combinations being 2 sites in the right free wall (29.5%) and right free wall and right septal area (15.9%). [24][25] Individuals with multiple ectopic foci revealed cardiovascular comorbidity, shortest tachycardia CL, and lower success rate of radiofrequency catheter ablation (RFCA).…”

Epicardial Mapping and Ablation of Cardiac Arrhythmias

“…Most posteroseptal accessory pathways that are closer to the epicardium than the endocardium are ablated from the coronary sinus, although epicardial mapping and ablation may be required [ 20 -23 ]. Atrial tachycardia requiring percutaneous epicardial mapping and ablation has also been reported; most patients have a focal atrial tachycardia arising from the region of the left atrial appendage [ 25 ].…”