Indications in children
Currently, no relevant guideline exists for the epicardial LAA AT
treatment in children. Although, endocardial CA was considered to be the
best strategy for the child in the present study if AT could be
terminated without any complications. The complex anatomy of the left
atrial appendage makes it a difficult intracardiac structure in which to
manipulate catheters
safely9. In one report,
firm forward pressure was exerted on the ablating catheter, causing the
appendage to
straighten9. However,
this maneuver could result in LAA
perforation10 and thus
was not attempted in the reported case.
Thus, the epicardial CA may be an alternative approach to endocardial
CA. CA using an epicardial access by a pericardial puncture may be
necessary and is a proven feasible route for the management of a variety
of arrhythmias6. But the
response to radiofrequency applications in epicardial areas differs
markedly from the response in endocardial areas because incomplete
ablation might result from a lack of contact with the ablation electrode
and the thermal homeostatic effect of cavitary saline infusion on the
LAA muscles11. And the
limited space of pericardial cavity makes it still difficult to
manipulate catheter safely.