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Updated: Jun 12, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Successful catheter ablation in an octogenarian with persistent atrial fibrillation complicated by cor triatriatum
Yusuke Okuyama1, Atsushi Tamura1, Kohei Ueda2
1Department of Cardiovascular Medicine, Uji-Tokushukai Medical Center, 145 Ishibashi, Makishima-cho, Uji, Kyoto Prefecture, 611-0041, Japan.
Insights
Catheter ablation successfully treated atrial fibrillation in an 80-year-old man with Cor triatriatum sinister (CTS), a rare congenital heart defect. This case highlights the safety and efficacy of ablation for AF in complex cardiac anomalies.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Electrophysiology
Background:
- Cor triatriatum sinister (CTS) is a rare congenital heart anomaly.
- Atrial fibrillation (AF) can complicate CTS, leading to significant symptoms.
- Catheter ablation (CA) is a treatment for AF, but rarely reported in CTS patients.
Observation:
- An 80-year-old male presented with shortness of breath and AF.
- Imaging revealed CTS with pulmonary veins draining into an accessory chamber.
- No other cardiac anomalies or thrombus were detected.
Findings:
- Pulmonary vein isolation (PVI) via CA was performed successfully using intracardiac echocardiography for precise guidance.
- The patient experienced symptom improvement and maintained sinus rhythm post-procedure.
- No complications occurred during the 4-day hospitalization and 18-month follow-up.
Implications:
- Detailed preoperative assessment with multiple imaging modalities is crucial for safe and effective CA in AF with CTS.
- This case demonstrates the feasibility of CA in elderly patients with complex congenital heart disease.
- Successful ablation offers a therapeutic option for symptomatic AF in patients with CTS.
Background:
Cor triatriatum sinister (CTS) is a rare congenital heart defect sometimes complicated with atrial fibrillation (AF). Catheter ablation (CA) relieves the AF-associated symptoms, but CA for AF with CTS has been reported rarely. Because CTS can be associated with other congenital heart disease, detailed preoperative assessment is important.
Case Summary:
An 80-year-old man was referred to our institution for shortness of breath that had persisted for 2 months when he was first diagnosed with AF. Transthoracic echocardiography revealed an enlarged left atrium (LA) divided into two chambers by a membrane. Transoesophageal echocardiography showed the membrane extending from the fossa ovalis (FO) to the Coumadin ridge, with the accessory (dorsal) chamber (AC) in closer proximity to the FO. Computed tomography showed that all pulmonary veins (PVs) flowed into the AC, with no PV anomalies. No other heart anomaly was identified, with no thrombus in the LA. With these findings, PV isolation (PVI) with CA was considered safe. Transseptal puncture was performed with intracardiac echocardiography for precise catheterization of the AC. Pulmonary vein isolation was performed successfully. The patient was discharged 4 days after the procedure, without any complications. His symptoms improved post-procedure, and sinus rhythm was maintained without antiarrhythmic drug therapy during the 18-month follow-up.
Discussion:
Cor triatriatum sinister is a rare anomaly that accounts for 0.1% of all congenital heart diseases. Cor triatriatum sinister sometimes complicated with symptomatic AF. Detailed preoperative anatomical assessment with multiple imaging modalities helped us achieve safe and effective CA for a patient with AF and CTS, even in an octogenarian.
