An incessant atrial tachycardia originating from epicardial left atrial appendage in a 12-year-old girl:ablation or excision?

To the Editor: Left atrial appendage (LAA) is one of the major sources of atrial arrhythmias in children.[1] But atrial tachycardia (AT) with an epicardial LAA origin is uncommon and usually arises from the base.[2] Catheter ablation (CA) may be an important strategy for patients with atrial arrhythmia,[3] especially due to the LAA firing trigger.[4] Due to a large number of trabeculations and true epicardial location, endocardial CA in LAA may fail or even cause fatal tamponade.[2,5] The epicardial CA may be an alternative approach.[6] Because the LAA has a very thin wall and may be prone to perforation, caution should be taken when LAA ablation is performed,[4] even during an epicardial ablation. There may be recurrence of AT, and surgical left atrial appendectomy (SAE) may be required.

Effect of combined catheter ablation of atrial fibrillation and left atrial appendage closure on left atrial structure compared with a single procedure

To the Editor:Atrial fibrillation(AF)is a well-recognized cause of left atrial(LA)structural remodeling.[1]LA sphericity(LASP),a new shape-based remodeling parameter,is an independent predictor for AF ablation outcome.[2,3]Improvement of LA structure was defined as LA reverse remodeling(RR).This study compared the impact of combined left atrial appendage(LAA)closure(LAAC)and catheter ablation(CA)of AF with a single procedure on LA volume(LAV)and LASP.