Pulsed-Field Ablation for Incessant Atrial Tachycardia Originating From the Left Atrial Appendage Apex.

BACKGROUND

Focal atrial tachycardias (ATs) originating from the left atrial appendage (LAA) apex are rare and challenging to treat given the high risk of cardiac perforation with conventional radiofrequency ablation.

CASE SUMMARY: A 15-year-old girl with an incessant AT arising from the LAA apex was successfully and safely treated using a novel contact force-sensing focal pulsed-field ablation (PFA) catheter with 10 applications. The patient remained asymptomatic, without tachycardia recurrence throughout a 4-month follow-up.

DISCUSSION: This first report demonstrates the safety and efficiency of PFA for AT arising from the LAA apex.

TAKE-HOME MESSAGES: For focal ATs originating from the LAA apex, a contact force-sensing focal PFA catheter is a viable alternative therapy. This approach enables targeted ablation of the arrhythmogenic focus while mitigating perforation risk, thus offering clinical utility for this challenging subset of focal ATs.