Combined pulsed field ablation of atrial fibrillation and left atrial appendage occlusion: A single-center experience.

BACKGROUND

Catheter ablation and left atrial appendage occlusion (LAAO) are frequently performed in patients with atrial fibrillation (AF). Pulsed field ablation (PFA) has emerged as a nonthermal ablation modality with a unique safety profile, but the feasibility and safety of combining PFA with LAAO remain largely unexplored.

OBJECTIVE

The purpose of this study was to evaluate the procedural feasibility, safety, and 1-year outcomes of combining AF PFA and LAAO in a single procedure.

METHODS

We collected 1-year outcomes of consecutive patients undergoing combined PFA and LAAO (Watchman FLX Pro device) at our institution between March 2024 and October 2024.

RESULTS

A total of 45 consecutive patients were included in this analysis (mean age 75 ± 8 years; 20 (44%) female; 25 (56%) persistent AF; mean CHA2DS2-VASc score 4.0 ± 1.4; mean HAS-BLED score 2.8 ± 1.1). The median procedural and fluoroscopy times were 90 minutes (interquartile range 80-107 minutes) and 24 minutes (interquartile range 18-30 minutes), respectively. Implant success was achieved in 44 patients (98%). Periprocedural complications occurred in 1 patient who developed pericarditis; no deaths, strokes, major bleeding events, or pericardial effusions requiring intervention were observed. All 45 patients had 1-year follow-up. During follow-up, there was 1 pericardial effusion requiring intervention and 1 major gastrointestinal bleeding event. At 45-day follow-up (n = 44), complete seal (0 mm peridevice leak) was achieved in 41 patients (93%), and 1 case of device-related thrombus was identified, which resolved with maintenance direct oral anticoagulant therapy and was absent on repeat imaging at 1 year. At 1 year, imaging was performed in 20 (44.45) patients, demonstrating complete seal in 18 (90%) and minor peridevice leak (≤3 mm) in 2 (10%) patients, with no device-related thrombus or device embolization observed.

CONCLUSION

Combined PFA and LAAO was feasible with high implant success, low periprocedural complication rates, and favorable outcomes through 1 year. This integrated approach offers a promising "1-stop" strategy for patients with AF requiring rhythm control and stroke prevention.