Incessant Atrial Tachycardia: Problem Solving With Minimally Invasive Surgery

Figure 1. Patient's first ECG during initial workup The negative P waves in leads I and aVL, together with their positivity in the inferior leads, are highly suggestive of an origin in the left atrial appendage.

Figure 2. Electroanatomical mapping of the left atria Multiple angles showing the activation latency of the left atria produced by the atrial tachycardia. The color gradient shows the time to activation, with red being the earliest and thus corresponding to the origin of the tachycardia, located near the tip of the left atrial appendage (marked with an asterisk). Panel A shows the mapping from an anterior view, B and C from differently angled left lateral views, and D from a regular left lateral view.

Figure 3. Left atrial appendage clipping as seen by thoracoscopy Surgeon's view during video-assisted thoracoscopic surgery. The clip (arrow) is being deployed in the neck of the left atrial appendage (asterisk), in order to isolate it from the rest of the left atrium.

Figure 4. Follow-up chest x-ray the day after surgery The atrial clip (arrow) can be seen in the correct position, and there are no signs of complications.