Surgical exclusion of focal paroxysmal atrial tachycardia

A 37 year old man with no evidence of structural heart disease presented with paroxysmal atrial tachycardia that could not be induced in the electrophysiology laboratory. Epicardial and endocardial mapping of the tachycardia performed in the operating room showed earliest activation at the junction of the right superior pulmonary vein and left atrium. An encircling incision excluded the portion of the left atrium containing the earliest point of activation and both right pulmonary veins from the remainder of the left atrium. The edges of the incision were then reapproximated. The patient is free of arrhythmias 6 months later. This technique should prove useful for the management of arhythmias arising from parts of the atria that are difficult to excise.