An incessant atrial tachycardia originating from epicardial left atrial appendage in a 12-year-old girl: ablation or excision?

Radiofrequency energy applications at multiple sites with early endocardial activation in LAA ostium did not terminate the tachycardia using a temperature of 43°C and power settings of 17 to 25 W. The patient was referred for surgery. At this site, radiofrequency application using a FlexAbility irrigated ablation catheter (St. Jude Medical) eliminated the tachycardia within 5 s of onset of energy (a temperature of 43°C, irrigation rate of 30 mL/min, and power settings of 30 W). [...]this maneuver could result in LAA perforation and thus was not attempted in the reported case. [...]the epicardial CA may be an alternative approach to endocardial CA. [6] But the response to radiofrequency applications in epicardial areas differs markedly from the response in endocardial areas because incomplete ablation might result from a lack of contact with the ablation electrode and the thermal homeostatic effect of cavitary saline infusion on the LAA muscles.