Percutaneous left atrial appendage occlusion following failed surgical ligation for incessant left atrial appendage tachycardia: key role of multimodality imaging.

We describe the case of a 31-year-old male with incessant left atrial appendage tachycardia and resultant severe left ventricular systolic dysfunction. Despite medical therapy, catheter ablation and surgical excision of the left atrial appendage with the AtriClip device, the tachycardia persistent. Following detailed multimodality workup including computational modelling with recreation of virtual implantation scenarios, the tachycardia was eventually terminated with pulsed field ablation and percutaneous left atrial appendage occlusion.