A Case of Left Atrial Cardiomyopathy Preceding to Left Atrial Dissection

A 45-year-old presented with atrial tachycardia 193 bpm. Electrophysiology study showed focal activation in the high interatrial septum, which was targeted with ablation without terminating tachycardia, suggesting a left atrial mechanism. Day 1 post procedure, she developed extensive left atrial haematoma across the posterior left atrium extending into the appendage (Panel A). After hematoma resolution, 12 months later, left atrial mapping was performed showing extensive scar (Panel B) with relative sparing of the posterior wall. Multiple organised tachyarrhythmias were inducible and targeted for ablation. Left atrial strain analysis performed on images obtained prior to dissection showed markedly reduced contractile, conduit, and reservoir values, indicating extensive pre-existing left atrial myopathy. This may have predisposed the patient to arrhythmia and mechanical fragility, contributing to atrial dissection.