Successful epicardial ablation of incessant left atrial tachycardia in a child with arrhythmia induced cardiomyopathy

Incessant supraventricular tachycardias leading to arrhythmia induced cardiomyopathy (AIC) is not uncommon. We report one such case of an incessant multidrug resistant focal left atrial tachycardia (AT) in a child who presented with AIC. During electrophysiology study this tachycardia was localized to the left atrial appendage (LAA) but, endocardial ablation at this site caused only temporary suppression of arrhythmia. The epicardial ablation at the site adjacent to the endocardial area proficiently terminated the tachycardia and improved the left ventricular function within the first 48 hours itself. Thus, this case report emphasizes the epicardial ablation of rare epicardial AT arising from LAA.