Abstract
BACKGROUND: The coexistence of focal atrial tachycardia (AT) originating from the left atrial appendage (LAA) with dual atrioventricular nodal pathways (DAVNP) is uncommon and presents distinct ablation challenges. CASE SUMMARY: A 31-year-old female woman with intermittent palpitations for 1 year was referred to our medical center for catheter ablation after an abnormal electrocardiogram. There was no personal or family history of cardiovascular disease or congenital anomalies. DISCUSSION: This case highlights the diagnostic complexity of a rare apical LAA-origin AT with DAVNP that required comprehensive electrophysiological study for confirmation. Successful focal ablation was achieved, prioritizing this strategy over LAA isolation given patient-specific factors and anatomical challenges. TAKE-HOME MESSAGE: The diagnosis of apical LAA AT with DAVNP is extremely challenging on electrocardiogram, requiring comprehensive mapping for diagnosis and for guiding a successful, individualized ablation strategy.