Ethanol Infusion Therapy for Incessant Atrial Tachycardia Arising From the Distal Left Atrial Appendage

INTRODUCTION: Atrial tachycardias (AT) originating from the distal left atrial appendage (LAAd) are rare and pose significant challenges during catheter ablation. This report describes a case of incessant AT arising from the LAAd that was successfully treated using ethanol infusion therapy. METHODS: A 70-year-old male patient with a history of incessant AT was referred to our center. Electrophysiological study and activation mapping were performed, revealing a focal AT originating from the LAAd with a cycle length of 544 ms (110 bpm). RESULTS: Endocardial catheter ablation attempts within the left atrial appendage (LAA) failed to terminate the tachycardia. The LAA vein was difficult to visualize but was detected using a guidewire. Ethanol infusion into the LAA vein resulted in immediate termination of the LAAd AT. The patient remained in sinus rhythm during a 14-month follow-up period. CONCLUSIONS: Chemical ablation with ethanol infusion may serve as an effective alternative therapeutic strategy for managing focal ATs originating from the LAAd, although the success of this approach is contingent upon the anatomical accessibility and distribution of the LAA vein.