Concomitant pulsed field ablation and LAA occlusion in two patients resulted in maintained sinus rhythm, no thromboembolic or bleeding events, and peridevice leak ≤2 mm at 6 months.
Case Report (n=2)
Does concomitant focal PFA and LAA occlusion with tailored sizing optimize device seal and clinical outcomes in patients with atrial fibrillation?
Focal pulsed field ablation can cause observable changes in LAA anatomy, suggesting that tailored device sizing may be necessary to optimize seal during concomitant LAA occlusion.
BACKGROUND: Concomitant atrial fibrillation ablation and left atrial appendage (LAA) occlusion are increasingly considered in patients with elevated thromboembolism and bleeding risk. Emerging data suggest a higher incidence of peridevice leak with pulsed field ablation (PFA). CASE SUMMARY: Two patients underwent concomitant PFA with the Sphere-9 catheter (Affera/Medtronic) and Watchman FLX Pro (Boston Scientific); postablation LAA changes were managed with tailored upsizing in one case and standard sizing in the other. At 6 months, both maintained sinus rhythm on antiplatelet therapy with no thromboembolic or bleeding events, and cardiac computed tomography confirmed well-seated devices with peridevice leak ≤2 mm. DISCUSSION: These are the first reported cases of concomitant LAA occlusion with Watchman FLX Pro and Sphere-9 PFA. Postablation LAA anatomical changes influenced device selection, and larger studies are needed to validate these findings. TAKE-HOME MESSAGES: Focal PFA led to specific, observable changes in LAA anatomy, directly affecting device sizing decisions. Tailoring device sizing to account for postablation LAA remodeling-using standard sizing or upsizing-may optimize device seal and compression.
Ergando et al. (Fri,) conducted a case report in Atrial fibrillation (n=2). Concomitant pulsed field ablation (Sphere-9) and LAA occlusion (Watchman FLX Pro) was evaluated on Sinus rhythm maintenance, thromboembolic or bleeding events, and peridevice leak. Concomitant pulsed field ablation and LAA occlusion in two patients resulted in maintained sinus rhythm, no thromboembolic or bleeding events, and peridevice leak ≤2 mm at 6 months.