Surgical and Ablation Therapies for Atrial Appendage Tachycardia in Children

BACKGROUND Atrial tachycardia (AT) originate from the atrial appendage present unique clinical challenges in pe- diatrics. It is typically persistent, frequently leading to tachycardiomyopathy, and poses significant treatment difficulties. OBJECTIVES This study aimed to collate and analyze the clinical characteristics and therapeutic outcomes of radio- frequency ablation (RFCA) and with atrial appendage resection for the treatment of AT originating from the atrial ap- pendages in pediatric patients. METHODS This retrospective study encompassed a cohort of 70 pediatric patients diagnosed with AT originating from the atrial appendage, identified through RFCA diagnostics. The study period spanned from January 2010 to February 2022 and provided a comprehensive analysis of patient outcomes following the treatment approaches. RESULTS The mean age was 6.94 f 3.46 years with the mean weight of 26.69 f 13.59 kg. Tachycardia cardiomyopathy developed in 44.3% (31 of 70 patients) of the patients. The immediate success rate of RFCA was 72.9% (51 of 70), whereas the recurrence rate after RFCA was 25.5% (13 of 51 patients). Thirty-two (45.7%) patients underwent atrial appendage resection because of unsuccessful ablation or recurrence. These included 20 right atrial appendage (RAA) and 12 left atrial appendages resections. Following resection, sinus rhythm was achieved in all patients without recurrence. Notably, RAA aneurysms were discovered in 45.0% (9 of 20 patients) of RAA resections, representing 22.5% (9 of 40) of RAA and 57.1% (8 of 14) of RFCA failures in AT originating from the RAA. CONCLUSIONS RFCA for AT originating from the atrial appendage in children has relatively low success and high recurrence rates. Electrophysiological mapping and surgical resection is a safe and effective alternative. In particular, in cases of AT originating from the RAA and unresponsive to RFCA, the possibility of an atrial appendage aneurysm should be considered. (JACC Clin Electrophysiol. 2025;11:400-407) (c) 2025 Published by Elsevier on behalf of the American College of Cardiology Foundation.