An incessant atrial tachycardia originating from epicardial left atrial
appendage in a 12-year-old girl: ablation or excision?
Aims The left atrial appendage (LAA) is one of the major sources of
atrial tachycardias (ATs) in children. However, endocardial ablation in
LAA may fail or even cause fatal tamponade; and epicardial ablation with
subsequent surgical appendectomy (SAE) may be required. There is no
relevant report in children. We aimed to evaluate the feasibility of
epicardial ablation with SAE in children. Methods and results The
epicardial ablation with SAE was performed in a 12-year-old girl with an
incessant AT. Endocardial mapping demonstrated endocardial activation
time of −112 msec and −105 msec (relative to the onset of the A wave at
CS9-10) in the right ventricular outflow tract and LAA, respectively.
But multiple ablation attempts at these sites did not terminate the AT.
After the left-side pericardium opened, the earliest activation (−120
msec) during AT was found at the apex of upper lobe. At this site,
ablation eliminated the tachycardia within 5 seconds of onset of energy.
After ablation, the LAA was excited, followed by a continuous over and
over suture to definitely close the resection line. The free of AT and a
decrease in LAD and NT-proBNP were achieved during the 12-month
follow-up. Conclusion The epicardial ablation with subsequent SAE was
successfully performed in a child. The heart function of the patient
improved after a 12-month follow-up. The excision of LAA may be an ideal
strategy for children with incessant AT originating from epicardial LAA.
However, the long-term safety and efficacy of SAE in children should be