Introduction We report a case of an underage girl whose main complaint was ”repeated episodes of tachycardia for five years, recurring and deteriorated for one day”. The patient was treated with drugs in the pediatric ward of Songshan General Hospital, but the effect was [undesirab](javascript:;)le. Then, she was transferred to cardiovascular department for secondary electrophysiological examination and radiofrequency ablation. Electrophysiological examination showed that the left wall concealed accessory pathway was accompanied by paroxysmal atrioventricular reentrant tachycardia and right atrial appendage tachycardia. The occult accessory pathway was cured after radiofrequency ablation, but the right atrial appendage tachycardia still remained. Finally the right atrial appendage ligation combined with radiofrequency ablation was adopted and satisfactory results were obtained. Combined with relevant document literature, this paper analyzes the ECG characteristics of right atrial appendage tachycardia, so as to provide a reference for clinical practice. Methods The concealed atrioventricular accessory pathway was cured after catheter ablation, but the right atrial appendage tachycardia could not be terminated by catheter ablation. The patient was transferred to cardiovascular surgery for right atrial appendage ligation and radiofrequency ablation. Results Over a month after the cardiac surgery, there was no any recurrence of tachycardia. Also, the symptoms like fatigue and shortness of breath improved. The echocardiography showed a significant improvement in the size of each chamber of the heart, an increase in EF(ejection fraction) and the improvement in valve regurgitation. Pericardial effusion disappeared after more than half a year of cardiac surgery. Conclusions Atrial appendage tachycardia is a common form of atrial tachycardia in children and can easily lead to tachycardia cardiomyopathy[1](#ref-0001). The efficacy of antiarrhythmic drug treatment is limited[2](#ref-0002). Complete healing through catheter ablation is challenging because of the integrated requirement of the interventional and surgical interventions.[3](#ref-0003)

Introduction We describe a rare case of an adolescent girl with paroxysmal atrial fibrillation originating from the right atrial appendage diverticulum and successfully converted to sinus rhythm after surgical intervention. Methods A 19-year-old girl was referred to the hospital for a catheter ablation of paroxysmal atrial fibrillation. Conventional ablation strategies are ineffective. Activation mapping showed the root of the free wall atrial appendage was first excited and catheter modeling (3D Carto map) shows a sac-like structure. Results We did selective angiography and further Computed tomography angiography (CTA) and Transesophageal ultrasonography (TTE) which showed diverticulum originating from the right atrial appendage. Hence the patient was referred to cardiac surgery and had no recurrent atrial fibrillation at three months postoperative follow up. Conclusions Right atrial appendage diverticula is an extremely rare malformation that can coexist with atrial tachyarrhythmia. Surgical ligation or excision of the abnormal structure with local ablation can achieve excellent results.