title: Percutaneous epicardial ablation of incessant atrial tachycardia originating from the left atrial appendage.
abstract: A 38-year-old woman presented with antiarrhythmic drug-refractory atrial tachycardia (AT). Holter recording demonstrated incessant episodes of AT followed by a long sinus pause. Electrophysiologic study revealed that the earliest endocardial activation was observed at the neck of the left atrial appendage (LAA). After unsuccessful endocardial ablation, epicardial access via a percutaneous subxiphoid approach demonstrated that the earliest epicardial atrial activation was observed on the opposite site to the endocardial LAA neck suggestive of ligament of Marshall (LOM) muscle sleeve as regarding the epicardial sharp potentials under guidance of a circular mapping catheter. Application of radiofrequency (RF) energy at this site terminated the tachycardia. After tachycardia ablation, the sinus pause also resolved.
authors.affiliation: Division of Cardiology, Department of Pediatrics, Hallym University Medical Center, Seoul, Republic of Korea.
authors.forename: Ji-Eun
authors.initials: JE
authors.lastname: Ban
authors.affiliation: Division of Cardiology, Department of Pediatrics, Hallym University Medical Center, Seoul, Republic of Korea.
authors.forename: Tae Young
authors.initials: TY
authors.lastname: Park
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Republic of Korea.
authors.forename: Sang-Weon
authors.initials: SW
authors.lastname: Park
keywords: Atrial tachycardia (AT); epicardial catheter ablation (EPI); left atrial appendage (LAA)