Pregnancy-Related Right Atrial Appendage Tachycardia Requiring ECMO and Hybrid Ablation.

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.