Successful video-assisted thoracoscopic atrial appendectomy in a 4-year-old child with intractable atrial tachycardia and tachycardia-induced cardiomyopathy

Abstract

A 4-year-old boy presented with intractable atrial tachycardia and heart failure. Antiarrhythmic drugs, such as digoxin, beta-blockers, and amiodarone were ineffective. Although we attempted multiple radiofrequency catheter ablations, the atrial tachycardia arising from left atrial appendage frequently recurred. Finally, we decided to perform atrial appendectomy using the thoracoscopic approach. Immediately after the appendectomy, the atrial tachycardia was terminated and restored to sinus rhythm. Left ventricular ejection fraction increased from 33 to 60% within 1 week. He had no arrhythmia during the subsequent 9-month follow-up period. Minimally invasive thoracoscopic surgery can be applied even in a small child who has focal atrial tachycardia originating from an atrial appendage.

Case report: Efficacy analysis of radiofrequency catheter ablation combined with atrial appendage resection for atrial tachycardia originating from the atrial appendage in children

“…Compared with traditional transthoracic incision surgery, video-assisted thoracoscopic surgery results in less bleeding during the operation, faster recovery, and less scarring. However, only one case of video-assisted thoracoscopic surgery has been reported in a child ( 19 ). In addition, there was a report of a 13-year-old boy who underwent thoracoscopic clamp RFCA to treat AT that originated from the RAA following the failure of catheter ablation ( 20 ).…”

Incessant Atrial Tachycardia: Problem Solving With Minimally Invasive Surgery

“…Surgical exclusion of the LAA is often performed to reduce the risk of systemic thromboembolism in patients with atrial fibrillation; however, this procedure is also capable of electrically isolating the LAA. There are few descriptions of surgical exclusion of the LAA as a treatment for AT [10][11][12] , and most of them are in the pediatric population; all of the reported cases showed termination of the tachycardia and no recurrence during follow-up. The use of uniportal VATS allows for a low risk of complications and short hospital stay, whilst not incurring the risks that could exist with catheter ablation; in fact, it even eliminates the risk of embolic events originating in the LAA.…”