Hybrid ablation in a patient with atypical atrial flutter originating from a left atrial appendage aneurysm: a case report

Left atrial appendage (LAA) aneurysm is a rare structural abnormality that can predispose to significant complications, including systemic embolism and complex supraventricular arrhythmias. Here, we report a 44-year-old female with a coexistent LAA aneurysm and persistent atypical atrial flutter (AFL). Despite cardioversion and medical therapy, she had recurrences of persistent AFL and continued to experience reduced exercise tolerance and chest pain. Computed tomography of the heart revealed a large LAA aneurysm measuring 51 × 53 × 25 millimeters. Due to the risk of perforation associated with catheter ablation, the procedure was abandoned. Following multidisciplinary evaluation, the patient underwent a hybrid thoracoscopic ablation with electrophysiological guidance and LAA aneurysm occlusion. At 12-month follow-up, she remained asymptomatic and maintained the sinus rhythm. This case illustrates that a hybrid ablation strategy can be a safe and effective option for patients with atypical atrial flutter originating from a left atrial appendage aneurysm when conventional catheter-based treatment is limited by anatomical or procedural constraints. Such personalized approaches may improve clinical outcomes in complex atrial arrhythmias.