Surgical ligation or excision with local ablation is an effective treatment for paroxysmal atrial fibrillation triggered by a right atrial appendage diverticulum.
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May inform rare diverticulum-triggered AF management; leaves open durability and generalizability pending larger studies.
Introduction We describe a rare case of an adolescent girl with paroxysmal atrial fibrillation originating from the right atrial appendage diverticulum and successfully converted to sinus rhythm after surgical intervention. Methods A 19-year-old girl was referred to the hospital for a catheter ablation of paroxysmal atrial fibrillation. Conventional ablation strategies are ineffective. Activation mapping showed the root of the free wall atrial appendage was first excited and catheter modeling (3D Carto map) shows a sac-like structure. Results We did selective angiography and further Computed tomography angiography (CTA) and Transesophageal ultrasonography (TTE) which showed diverticulum originating from the right atrial appendage. Hence the patient was referred to cardiac surgery and had no recurrent atrial fibrillation at three months postoperative follow up. Conclusions Right atrial appendage diverticula is an extremely rare malformation that can coexist with atrial tachyarrhythmia. Surgical ligation or excision of the abnormal structure with local ablation can achieve excellent results.
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Cheng et al. (2023) studied this question.
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