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Updated: Oct 17, 2026

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Pregnancy-Related Right Atrial Appendage Tachycardia Requiring ECMO and Hybrid Ablation
Wenqi Han1, Haichao Chen1, Yi Wang1
1Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China.
Background:
Right atrial appendage atrial tachycardia (AT) during pregnancy is rare and can progress to tachycardia-induced cardiomyopathy and shock.
Case Summary:
A 22-year-old woman at 36 weeks and 5 days of gestation presented with fatigue, dyspnea, and narrow-complex tachycardia at 190-210 beats/min. Echocardiography showed an ejection fraction of 18%. After failed medical therapy, cardioversion, and esophageal pacing, she underwent emergency cesarean delivery and venoarterial extracorporeal membrane oxygenation. Mapping localized the AT to the base of the right atrial appendage; endocardial radiofrequency (RF) and pulsed field ablation produced only transient sinus rhythm. Thoracoscopic bipolar RF ablation with surgical clamping restored durable sinus rhythm.
Conclusions:
Appendage-origin AT in pregnancy can progress rapidly to tachycardia-induced cardiomyopathy, and timely venoarterial extracorporeal membrane oxygenation support improves the prognosis. RF and pulsed field ablation may be insufficient for deep or possibly epicardial substrates; surgical ablation should be considered when catheter ablation fails.
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