Thoracoscopic resection of the left atrial appendage after failed focal atrial tachycardia ablation.
BACKGROUND
This case series describes 3 patients with the unusual location of focal atrial tachycardia in the left atrial appendage who failed catheter ablation but were successfully treated by left atrial appendage resection by a totally thoracoscopic surgical technique.


METHODS
In all 3 cases, left atrial appendage resection was carried out by video-assisted thoracoscopic surgery using only 3 5- to 10-mm incisions, eliminating the need for median sternotomy or thoracotomy. An endoscopic stapler was used to resect the left atrial appendage at its base, successfully eliminating the source of the patients' focal atrial tachycardia.


RESULTS
The mean operative time was 84 minutes. All 3 patients tolerated the procedure without any complications and were discharged on postoperative day 3. At an average follow-up of 4.5 years, all patients remained asymptomatic and with normal ambulatory rhythm monitoring off all antiarrhythmic medications.


CONCLUSIONS
Surgical resection of the left atrial appendage using a totally thoracoscopic approach is a safe and successful treatment option for patients who have failed endocardial catheter ablation. This novel approach utilizes smaller incisions and shorter operative times than the more invasive surgical techniques previously described in the literature.
Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina.
Rachel D
RD
Torok
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Benjamin
B
Wei
Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina.
Ronald J
RJ
Kanter
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Robert D B
RD
Jaquiss
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina. Electronic address: andrew.lodge@dm.duke.edu.
Andrew J
AJ
Lodge
D000293:Adolescent; D000328:Adult; D020517:Atrial Appendage / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods; D017115:Catheter Ablation; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013610:Tachycardia / Q000601:surgery*; D013906:Thoracoscopy; D017211:Treatment Failure