An original management of focal atrial tachycardia originating from a giant left atrial appendage

Key Teaching Points•The management of symptomatic atrial tachycardia resistant to drug therapy must be done by endocavitary ablation.•Computed tomography scan of the left atrium should be performed frequently. It can highlight anatomical particularity that will lead to an adaptation of the ablation procedure.•Success rate of ablation of an atrial tachycardia originating from the left atrial appendage is close to 70% according to the series. The thoracoscopic surgical approach appears to be a good alternative after failure of endocavitary ablation. •The management of symptomatic atrial tachycardia resistant to drug therapy must be done by endocavitary ablation.•Computed tomography scan of the left atrium should be performed frequently. It can highlight anatomical particularity that will lead to an adaptation of the ablation procedure.•Success rate of ablation of an atrial tachycardia originating from the left atrial appendage is close to 70% according to the series. The thoracoscopic surgical approach appears to be a good alternative after failure of endocavitary ablation.