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Surgical treatment of atrial tachycardia arising from left atrial appendage

Focal atrial tachycardia arising from the left atrial appendage (LAA) is less frequently encountered in clinical practice. Catheter ablation of this focal tachycardia is the main treatment and has a high success rate. Surgical radiofrequency isolation plus external closure of the appendage is an option in patients' refractory to catheter methods. An 18-year-old male patient was admitted to our hospital with a diagnosis of tachycardia-induced cardiomyopathy (ejection fraction 35%). His electrophysiological study revealed a centrifugal activation pattern in the LAA where local atrial activation was earliest. Sinus rhythm was not achieved despite multiple attempts. Surgery was planned to isolate the source of the refractory arrhythmia. LAA of the patient was electrically isolated by using AtriCure® Synergy Ablation Clamp through the left anterior mini-thoracotomy. Sinus rhythm was restored right after successful isolation. AtriClip® PRO device was used to externally exclude the LAA to eliminate possible thrombus formation in isolated appendage. Surgical ablation methods are valid and successful options in patients who are refractory to medical and catheter methods. Dedicated arrhythmia teams (cardiologists, electrophysiologists, and cardiac surgeons) have the potential to increase patients' outcomes.