Pulsed-Field Ablation With Transcatheter Left Atrial Appendage Occlusion for Left Atrial Appendage-Origin Atrial Tachycardia.

BACKGROUND

Pulsed-field ablation (PFA) may be an emerging treatment for left atrial appendage (LAA)-origin atrial tachycardia (AT), but it may cause thrombus in the LAA. Concomitant transcatheter LAA occlusion (LAAO) may address this risk.

CASE SUMMARY: A 54-year-old man with symptomatic LAA-origin AT underwent PFA. Post-PFA transesophageal echocardiography showed significant pectinate muscle edema with narrowing of the LAA orifice. To avoid late peridevice leak, a 40-mm Watchman FLX Pro (Boston Scientific) was implanted with intentional overcompression. At the 1-month follow-up, cardiac computed tomography demonstrated a complete LAA seal with adequate device compression.

DISCUSSION: Concomitant PFA and LAAO is feasible for LAA-origin AT. Because PFA can induce significant edema within the LAA, device selection based on pre-PFA imaging is critical to ensure durable sealing.

TAKE-HOME MESSAGES: Careful pre-PFA imaging-based device sizing is critical when combining PFA with LAAO in patients with LAA-origin AT.