Totally Endoscopic Left Atrial Appendectomy For Treatment Of Atrial Tachycardia
Toshiya Ohtsuka, Norihiko Ishikawa, Go Watanabe.
New-heart Watanabe International Institute, Tokyo, Japan.
BACKGROUND: It is not uncommon that the focus of atrial tachycardia (AT) exists in the left atrial appendage (LAA). We retrospectively evaluated our clinical experience with totally endoscopic resection of the LAA for treatment of such AT foci.
METHODS: The patients had received a catheter examination for electro-physiological mapping but the therapeutic ablation was given up or failed since the AT focus existed in the LAA. The LAA resection was performed using an endoscopic cut-and-staple device.
RESULTS: 21 patients (16/5 men/women; mean age: 38 years old [range 13-61]; mean AT history: 3.3 years [range 1-7]) were treated. The procedure was uneventfully accomplished using totally endoscopic port-access technique in all cases. The LAA resection alone was performed in 18 cases and the en bloc isolation technique that allows for electrical isolation of a whole LAA system was added using a radiofrequency clamp-isolation device (Figure) in 3 cases. The mean procedural time was 22 min (range 15-31). Instantly after the LAA was resected or en bloc isolation was performed, AT disappeared on EKG and normal sinus rhythm was recovered in all the patients. Any antiarrhythmic drugs were eliminated from every patient. During 51 months of the mean follow-up period, AT recurred in no patients.
CONCLUSIONS: Catheter ablation for treatment of AT becomes dangerous and difficult when the focus exists in the fragile LAA. The present technique is a safe and highly curative endoscopic surgical solution in such patients. 
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