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.