Consideration of surgical appendectomy
The LAA is one of the major sources of ATs in
children1. The mechanism
of AT originating in the LAA is unknown. Intracellular recordings
demonstrated that the mechanism was abnormal
automaticity2. Histology
showed that spontaneous activity arose in an area with abnormal
cells2. However, CA in
an atrial appendage may fail or there may be recurrence of AT; and
surgical appendectomy may be
required2,
5. Because the LAA has a very thin wall
and may be prone to perforation, caution should be taken when LAA
ablation is performed4,
even if epicardial ablation.
In the current case, because of its favorable risk–benefit ratio rather
than a second attempt at catheter ablation, we chose epicardial catheter
ablation with subsequent SAE. The patient’s heart function improved with
significantly decreased LVEDD, LAD and enhanced NYHF.