One-Stop Strategy Combining Pulmonary Vein Isolation With Balloon-in-Basket Pulsed Field Ablation and Left Atrial Appendage Closure: a case report

Abstract Background Concomitant pulmonary vein isolation (PVI) and left atrial appendage closure (LAAC) is increasingly performed, with substantial experience from thermal ablation and limited early reports using pulsed field ablation (PFA). This is the first reported case of a combined procedure using a balloon-in-basket PFA system. Case summary A 75-year-old man with symptomatic paroxysmal atrial fibrillation (AF) and recurrent macrohematuria under oral anticoagulation was referred for treatment. After a multidisciplinary team discussion, we opted for a one-stop approach combining PVI using a balloon-in-basket PFA system and LAAC. The procedure proceeded without complications, and at the end of the procedure and in follow-up imaging, no residual leak was detected. Discussion This case highlights the feasibility of combining balloon-in-basket based PFA with LAAC in a single procedure. Performing ablation prior to LAAC may help avoid potential interactions between the ablation catheter and the occlusion device, while careful procedural planning can ensure optimal device sizing and complete sealing of the appendage, even in the context of post-ablation tissue changes.