Key result
Thoracoscopic surgical ablation restores durable sinus rhythm after failed catheter ablation in refractory gestational atrial tachycardia.
Why the study?
Right atrial appendage atrial tachycardia during pregnancy is rare and can rapidly progress to tachycardia-induced cardiomyopathy and shock, requiring advanced management strategies.
Does thoracoscopic surgical ablation and VA-ECMO support restore durable sinus rhythm in a pregnant patient with refractory right atrial appendage tachycardia and shock?
Case Report (n=1)
Does thoracoscopic surgical ablation and VA-ECMO support restore durable sinus rhythm in a pregnant patient with refractory right atrial appendage tachycardia and shock?
In pregnant patients presenting with rare right atrial appendage tachycardia and cardiogenic shock, early VA-ECMO support and surgical ablation can be life-saving when standard endocardial catheter ablation fails.
BACKGROUND: Right atrial appendage atrial tachycardia (AT) during pregnancy is rare and can progress to tachycardia-induced cardiomyopathy and shock. CASE SUMMARY: A 22-year-old woman at 36 weeks and 5 days of gestation presented with fatigue, dyspnea, and narrow-complex tachycardia at 190-210 beats/min. Echocardiography showed an ejection fraction of 18%. After failed medical therapy, cardioversion, and esophageal pacing, she underwent emergency cesarean delivery and venoarterial extracorporeal membrane oxygenation. Mapping localized the AT to the base of the right atrial appendage; endocardial radiofrequency (RF) and pulsed field ablation produced only transient sinus rhythm. Thoracoscopic bipolar RF ablation with surgical clamping restored durable sinus rhythm. CONCLUSIONS: Appendage-origin AT in pregnancy can progress rapidly to tachycardia-induced cardiomyopathy, and timely venoarterial extracorporeal membrane oxygenation support improves the prognosis. RF and pulsed field ablation may be insufficient for deep or possibly epicardial substrates; surgical ablation should be considered when catheter ablation fails.
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Han et al. (2026) conducted a case report in Right atrial appendage atrial tachycardia during pregnancy (n=1). Thoracoscopic bipolar RF ablation with surgical clamping was evaluated on Restoration of durable sinus rhythm. Thoracoscopic bipolar radiofrequency ablation with surgical clamping successfully restored durable sinus rhythm after catheter ablation failed in a pregnant woman with atrial tachycardia.
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