Management of recurred atrial appendage tachycardia: repetitive catheter ablation vs. thorascopic atrial appendectomy

Abstract

Objective The outcome of different management for patients with refractory atrial appendage tachycardia (AAT), after initial radiofrequency catheter ablation (RFCA), is unknown. We tried to compare the mid/long-term outcome of video-assisted thoracoscopic (VAT), atrial appendectomy and re-do RFCA in treating patients with relapsed AAT after initial RFCA. Methods Nineteen consecutive patients with underwent initial failed RFCA for AAT were studied. Five of them resorted to video-assisted thoracoscopic (VAT), atrial appendectomy (atrial appendectomy cohort), and 14 received re-do RFCA (RFCA cohort). We investigated the mid/long-term outcomes of the two cohorts. Results After a mean follow up of (353±217), days, no patients experienced recurrence in atrial appendectomy cohort, while 8 out of 14 patients (57.1%), in the RFCA cohort experienced recurrence. Log-Rank analysis observed significant differences between two cohorts (P=0.049). No major complications were reported in either cohort. Larger earliest 10 ms activation area in the endocardial atrial appendage, as well as more antiarrhythmic drug resistance indicated recurrence for patients who underwent redo-RFCA. Conclusion VAT atrial appendectomy may be a reasonable option for patients with relapsed AATs after the initial RFCA Key words: Atrial appendage tachycardia; Recurrence; Atrial appendectomy; Catheter ablation