{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T09:47:42Z","timestamp":1782553662555,"version":"3.54.5"},"reference-count":10,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T00:00:00Z","timestamp":1782518400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T00:00:00Z","timestamp":1782518400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Focal atrial tachycardia (AT) originating from a right atrial appendage (RAA) diverticulum is rare in children and often poses significant challenges for conventional radiofrequency catheter ablation (RFCA) due to limited catheter access and poor tissue contact. We report the successful use of transcatheter 95% ethanol chemical ablation as a bailout strategy in a child with recurrent AT and suspected arrhythmia\u2010induced cardiomyopathy (AIC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>A 10\u2010year\u20105\u2010month\u2010old boy with a history of incessant AT and severe left ventricular dysfunction (LVEF 23%) was diagnosed with suspected AIC. Although initial RFCA successfully terminated the tachycardia, AT recurred 2.5\u00a0months later. Repeat electrophysiological study with high\u2010density mapping localized the earliest activation to the RAA roof. Intraprocedural right atrial angiography revealed a transversely oriented diverticulum\u2010like sac arising from the RAA roof, communicating with the prior ablation site and preventing stable catheter engagement. Transcatheter chemical ablation was performed using an ST Blue ablation catheter positioned at the ostium of the diverticulum\u2010like structure. After confirmation of selective contrast opacification without extravasation, a test bolus of 1\u00a0mL 95% ethanol was infused, resulting in immediate termination of the AT. A total of approximately 10\u00a0mL ethanol was delivered incrementally. Consolidation radiofrequency applications were then performed at the ostium to electrically isolate the ablated region. The procedure was uneventful, with no complications. Post\u2010procedural monitoring confirmed non\u2010inducibility of AT, and the patient remained arrhythmia\u2010free at short\u2010term follow\u2010up with stable left ventricular function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case demonstrates the feasibility and efficacy of bailout transcatheter ethanol ablation for recurrent AT arising from an inaccessible RAA diverticulum\u2010like structure in a pediatric patient with AIC. Intraprocedural angiography was crucial for identifying the anatomical substrate. Ethanol chemical ablation may serve as a safe and effective alternative when conventional catheter ablation fails due to complex anatomy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pace.70331","type":"journal-article","created":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T09:36:52Z","timestamp":1782553012000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Transcatheter Ethanol Ablation of Recurrent Right Atrial Appendage Diverticulum\u2010Related Atrial Tachycardia in a Child"],"prefix":"10.1111","author":[{"given":"Wenjing","family":"Zhu","sequence":"first","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine Shandong Provincial Hospital Affiliated to Shandong First Medical University  Jinan Shandong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology Shandong Provincial Hospital Affiliated to Shandong First Medical University  Jinan Shandong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8098-4692","authenticated-orcid":false,"given":"Jianli","family":"Lv","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology Shandong Provincial Hospital Affiliated to Shandong First Medical University  Jinan Shandong China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,27]]},"reference":[{"issue":"7","key":"e_1_2_12_2_1","first-page":"9502","article-title":"Recurrent Atrial Tachycardia After Catheter Ablation Due to Right Atrial Diverticulum","volume":"12","author":"Xu H. X.","year":"2019","journal-title":"International Journal of Clinical and Experimental Medicine"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjcr\/ytae497"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrcr.2024.03.001"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.08.038"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2024.1431736"},{"issue":"6","key":"e_1_2_12_7_1","doi-asserted-by":"crossref","first-page":"1426","DOI":"10.1111\/jce.16662","article-title":"Ethanol Infusion Therapy for Incessant Atrial Tachycardia Arising From the Distal Left Atrial Appendage","volume":"36","author":"Li J. Y.","year":"2025","journal-title":"Journal of Cardiovascular Electrophysiology"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.113.001423"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12872\u2010024\u201003789\u2010z"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.15966"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrcr.2022.06.006"}],"container-title":["Pacing and Clinical Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70331","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/pace.70331","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70331","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T09:36:53Z","timestamp":1782553013000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pace.70331"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,27]]},"references-count":10,"alternative-id":["10.1111\/pace.70331"],"URL":"https:\/\/doi.org\/10.1111\/pace.70331","archive":["Portico"],"relation":{},"ISSN":["0147-8389","1540-8159"],"issn-type":[{"value":"0147-8389","type":"print"},{"value":"1540-8159","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,27]]},"assertion":[{"value":"2026-05-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"pace.70331"}}