Underdevelopment of Left Atrial Appendage

Area of Science:

• Cardiology
• Cardiac Electrophysiology
• Medical Imaging

Background:

• Atrial fibrillation (AF) is a common arrhythmia requiring effective treatment.
• Anatomical variations, such as absence of the left atrial appendage (LAA), can influence therapeutic strategies.
• Understanding the implications of LAA absence is crucial for successful AF management.

Purpose of the Study:

• To report the successful catheter ablation of atrial fibrillation in a patient with congenital absence of the left atrial appendage.
• To evaluate the safety and efficacy of AF ablation in the presence of anatomical variations.
• To assess the long-term maintenance of sinus rhythm post-ablation.

Main Methods:

• Cardiac computed tomography (CCT) and transesophageal echocardiography (TEE) were used for anatomical assessment.
• Catheter ablation was performed using standard electrophysiological techniques.
• Antiarrhythmic drug therapy was initiated post-procedure.

Main Results:

• CCT and TEE confirmed the absence of the left atrial appendage.
• The right atrial appendage appeared normal, with normal pro-B-natriuretic peptide levels.
• Catheter ablation was technically successful without procedural complications.
• Sinus rhythm was maintained for 10 months under antiarrhythmic drug therapy.

Conclusions:

• Catheter ablation is a viable and effective treatment for atrial fibrillation, even in patients with congenital absence of the left atrial appendage.
• Absence of the LAA does not preclude successful AF ablation or long-term rhythm control.
• Comprehensive pre-procedural imaging is essential for identifying anatomical variations that may impact ablation strategies.