En Bloc Left Pulmonary Vein and Appendage Isolation in Thoracoscopic Surgery for Incessant Atrial Tachycardia

Hiroshi Ito; Soichi Ike; Masaya Takahashi; Osamu Yamashita; Masahiro Hisaoka; Shinsuke Suzuki

doi:10.1016/j.jaccas.2025.106253

En Bloc Left Pulmonary Vein and Appendage Isolation in Thoracoscopic Surgery for Incessant Atrial Tachycardia

JACC Case Rep. 2026 Jan 28;31(4):106253. doi: 10.1016/j.jaccas.2025.106253. Epub 2025 Dec 3.

Authors

Hiroshi Ito¹, Soichi Ike², Masaya Takahashi², Osamu Yamashita², Masahiro Hisaoka³, Shinsuke Suzuki³

Affiliations

¹ Department of Cardiovascular Surgery, Saiseikai Shimonoseki General Hospital, Shimonoseki, Yamaguchi, Japan. Electronic address: h-ito@simo.saiseikai.or.jp.
² Department of Cardiovascular Surgery, Saiseikai Shimonoseki General Hospital, Shimonoseki, Yamaguchi, Japan.
³ Department of Cardiology, Saiseikai Shimonoseki General Hospital, Shimonoseki, Yamaguchi, Japan.

Abstract

Background: Atrial tachycardia (AT) originating from the distal left atrial appendage (LAA) is rare, especially in older adult patients.

Case summary: A 64-year-old man was admitted for heart failure due to drug- and ablation-resistant AT. The arrhythmia was traced to the distal LAA. Owing to high risk of recurrence and complications with repeat catheter ablation, the patient underwent total thoracoscopic en bloc isolation of the left pulmonary veins and LAA, followed by LAA resection.

Discussion: Sinus rhythm was restored intraoperatively and was maintained postoperatively without antiarrhythmic medication. Left ventricular ejection fraction improved from 20% to 51% over 12 months. No recurrence of AT or heart failure was observed at the 12-month follow-up.

Take-home message: This case highlights the efficacy and safety of combining thoracoscopic LAA resection with en bloc isolation in treating AT originating from the LAA in older adult patients.

Keywords: atrial tachycardia; minimally invasive surgery; radiofrequency ablation; tachycardia-induced cardiomyopathy; totally thoracoscopic left atrial ablation and appendage closure.

Publication types

Case Reports