Left atrial appendage aneurysm (LAAA) is a rare and often underdiagnosed cardiovascular anomaly with potentially serious complications, including arrhythmias and thromboembolic events. This report presents the case of a 36-year-old woman who developed LAAA after a recent viral respiratory infection. She presented with palpitations and atrial tachyarrhythmia, and transthoracic echocardiography (TTE) revealed a 5.6 x 3.5 cm aneurysmal left atrial appendage (LAA) with a reduced left ventricular ejection fraction of 50%. Cardiac computed tomography and cardiac magnetic resonance imaging confirmed the diagnosis, revealing a “smoky appearance” concerning blood flow dynamics and late gadolinium enhancement consistent with prior myocarditis. The patient successfully underwent minimally invasive endoscopic thoracoscopic aneurysm resection with cardiopulmonary bypass and transesophageal echocardiographic (TEE) guidance. No thrombus was found during preoperative TEE, and her postoperative recovery was smooth, with restored sinus rhythm, improved left ventricular function (55%), and no arrhythmias during follow-ups. This case highlights the crucial role of multimodal imaging, particularly echocardiography, in diagnosing and managing LAAA, while also drawing attention to a potential association with viral myocarditis. The successful use of minimally invasive surgical techniques underscores their value in optimizing outcomes for this rare condition, warranting further investigation to guide future practice.

Background and Aims: We evaluated whether cardiac memory T-wave (CMT) is associated with reverse remodeling of left ventricular as an indicator of response to cardiac resynchronization therapy (CRT). Methods and Results: CMT was defined as a negative T-wave in right and mid precordial leads with negative wide QRS complexes before CRT implantation. We studied 100 patients (50 consecutive patients with CMT and 50 consecutive patients without CMT) who underwent CRT. Patients’ resting 12-lead ECGs before and immediately after implantation of CRT were analyzed by an electrophysiologist to confirm the presence or absence of CMT. Response to CRT was defined as at least one NYHA class decrease and ≥15% decrease in left ventricular end-systolic volume (LVESV) 6 months after CRT implantation. Patients with and without CMT were compared in terms of response to CRT. The number of patients with CMT who responded to CRT was higher in comparison to the patients without CMT (64% vs, 36%, p<0.001). In the multivariate regression model, CMT remained associated with response to CRT after adjusting for baseline characteristics [odds ratio (OR) (95% CI) 4.79 (2.01–11.43), P < 0.001]. Conclusion: There is a strong relationship between the presence of CMT as a marker of reversed ventricular remodeling and the response to CRT. Moreover, since CMT occurs just after CRT implantation, it can be considered as an early valuable predictor of response to CRT. Consequently, the presence of CMT can be administered as a measure of response to CRT.

Introduction:

34 years old man with frequent palpitations referred to our center. Three standard diagnostic catheters were introduced through left and right femoral veins and placed in right atrium, right ventricle and coronary sinus positions. A narrow complex tachycardia with long RP-short PR could be initiated after extarstimulation from HRA following an AV nodal jump. The earliest retrograde atrial activation was recorded from His bundle position. RV apical pacing showed decremental with earliest atrial activation in His area, although no fused V-A potential was recorded in either CS or His position. His synchronous pacing from RV apex failed to advance or reset the arrhythmia. Morady maneuver by RV overdrive pacing repeatedly terminated the tachycardia. Mapping was initiated from His region and extended to all anticipated areas from parahisian region to tricuspid annulus, posteroseptal TV ring and CS. The construction of RA activation map failed to reveal earliest activation site. Mapping catheter was introduced through femoral artery and advanced to the left ventricle. At anteroseptal mitral annulus corresponding to Aorto-Mitral continuity, we recorded the earliest retrograde atrial activation (A-distal CS =50 ms). RF energy (30 W) was delivered using an irrigate tip catheter during tachycardia and resulted in termination of tachycardia immediately.