New Insight of Electrophysiologic Characteristics and Ablation of Focal Atrial Tachycardia Originating from Left Atrial Appendage

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Background: Several cases about ATs originating from left atrial appendage (LAA) were reported, but detailed electrophysiologic characteristics of LAA-ATs are not well-known. Objectives: The purpose of this study was to define mechanism and characteristics of the atrial tachycardia (AT) originating from the left atrial appendage (LAA). Methods and Results: Three patients with LAA-AT were included in this study. Electrical pacing and pharmacological evaluation ware performed to test characteristics of LAA-ATs. LAA-gram was performed prior to ablation to confirm anatomical characteristics of LAA. Mechanism of LAA-ATs was automaticity in 2 and lasting at least 10 years and triggered activity in 1. Any drugs were resistant in 2 automaticity ATs, but Na channel-blocker and β-blocker were well affected in triggered AT. 2 foci were located at apex on medial site of LAA, and 1 focus at base. Ring catheter in LAA was helpful to identify the earliest activation site and mapping in the LAA. ATs were eliminated by CA at the earliest activation site where local potential preceded to P wave onset by 60±12 ms. All patients were free from any arrhythmias without any antiarrhythmic drugs follow-up 3±1 years. Conclusion: These data showed that LAA-ATs were uncommon site of origin for focal ATs, but focal intra-LAA ablation was safe and effective to cure these ATs.