A LARGE RIGHT ATRIAL APPENDAGE ANEURYSM RESECTION AND INTRAOPERATIVE ACCESSORY PATHWAY ABLATION (HYBRID PROCEDURE)

A 32-year-old male, who was diagnosed with supraventricular tachycardia (SVT) and was kept on medical treatment, developed recurrent SVT and was scheduled for percutaneous electrophysiological study (EPS) and ablation, pre-procedural investigation revealed a large thin-walled cystic mass anterior to right ventricle (RV) which was confirmed to be a large right atrial appendage aneurysm (RAAA) by transesophageal echocardiography (TEE) and cardiac magnetic resonance imaging (CMRI), Catheter ablation failed in spite of many times of radiofrequency energy delivery which was attributed to the complexity of the anatomy due to the RAAA, so combined RAAA resection and intraoperative ablation of the accessory pathway were performed successfully.

Learning objective: Catheter ablation of accessory pathway in patients with supraventricular tachycardia is one of the main stay of treatment, RAAAs are rarely encountered, they are most often congenital, they can present at any age usually in the third decade of life, they can present with palpitation, dyspnea or accidentally discovered, TEE and CMRI are crucial in the diagnoses and management, and combined surgical resection of RAAA and intraoperative ablation of accessory pathway can be performed successfully.