Feasibility, Procedural Efficiency, and Early Imaging Outcomes of Concomitant Pulsed Field Ablation and Left Atrial Appendage Closure: A Prospective Single-Center Study.

Figures

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  Figure 1. Pre-procedural imaging and intraprocedural planning workflow for LAAC. CT and AI-based planning were used when feasible, with intraprocedural TEE/ICE-based sizing in patients with contrast limitations. Panel 1 shows CT 3D reconstruction of the LAA used for anatomical assessment and sizing. Panel 2 demonstrates AI-based modelling to evaluate optimal device size and landing-zone position. Panel 3 shows intraprocedural TEE and ICE imaging used to guide device positioning and confirm seal criteria. Panel 4 shows post-ablation remeasurement of the LAA prior to final device sizing and deployment. This workflow supported standardized sizing and imaging-confirmed device deployment.

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  Figure 2. Representative ICE imaging and 3D EAM reconstructions during PFA enabling a zero-fluoroscopy pulmonary vein isolation strategy using different catheter platforms. Left panels show ICE imaging of multiple PFA catheter platforms during LA navigation and ablation, including positioning within the PVs, PW, and SVC. ICE provided real-time confirmation of catheter location and tissue contact, enabling a fluoroscopy-free PFA PVI workflow. Right panels show 3D EAM reconstructions across platforms: a pentaspline PFA catheter on Opal HDx (top), a circular PFA catheter on EnSite X (middle), and a lattice-tip catheter on Prism (Affera) (bottom). Maps depict LA anatomy and PFA lesion delivery for PVI, including PW and adjunctive targets when performed, within a standardized workflow.

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  Figure 3. Intraprocedural and follow-up imaging for LAAC device assessment. Panel 1 shows fluoroscopic imaging during device implantation. Panel 2 shows intraprocedural TEE and ICE used to confirm device position and assess release criteria prior to implantation. Panel 3 shows follow-up CT imaging at approximately 3 months used to assess device position and peri-device seal; CT was performed in 80% of patients for leak assessment, with TEE used in the remaining 20%.