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

Figures

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  Visual Summary. Concomitant PFA and Transcatheter LAAO for LAA-Origin AT As PFA can induce acute postablation LAA edema, device sizing based on preablation imaging is critical. AT = atrial tachycardia; LAA = left atrial appendage; LAAO = left atrial appendage occlusion; PFA = pulsed-field ablation.

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  Figure 1. Index 12-Lead Electrocardiograms Electrocardiograms documenting LAA-origin AT and sinus rhythm for comparison. AT = atrial tachycardia; LAA = left atrial appendage.

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  Figure 2. 3-Dimensional Activation Mapping at the First Session Activation mapping identifying the earliest atrial activation within the LAA with centrifugal spread to the left atrium. LAA = left atrial appendage; LIPV = left inferior pulmonary vein; LSPV = left superior pulmonary vein; RIPV = right inferior pulmonary vein; RSPV = right superior pulmonary vein.

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  Figure 3. LAA Orifice Diameter Findings: Comparison Before and After PFA (A) Preprocedural cardiac CT demonstrating a cactus-shaped LAA with a maximum diameter of 34 mm. Intraprocedural TEE at a 135° angle view (B) before and (C) after PFA showed acute edema of the pectinate muscle with ostial narrowing and contour change caused by PFA, reducing the maximal diameter from 32 mm (B) to 27 mm (C). CT = computed tomography; PFA = pulsed-field ablation; TEE = transesophageal echocardiography; other abbreviations as in Figure 2.

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  Figure 4. Findings on LAA Angiography (A) LAA angiography in the right anterior oblique 30° and caudal 30° views. (B) Fluoroscopic image during PFA at the same projection. LAA = left atrial appendage.

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  Figure 5. Left Atrial Voltage Mapping Before and After PFA (A) Pre-PFA left atrial voltage map showing preserved potentials across the LAA-ostial region. (B) Post-PFA voltage map demonstrating abolition of LAA potentials; entrance and exit block were confirmed by pacing maneuvers and lack of capture from within the LAA. LAA = left atrial appendage; PFA = pulsed-field ablation.

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  Figure 6. Intraprocedural TEE Findings During LAAO A 40-mm device was deployed according to the preablation plan with intentional overcompression (29%), yielding stable seating and no peridevice leak on color Doppler. LAAO = left atrial appendage occlusion; TEE = transesophageal echocardiography.

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  Figure 7. Follow-Up CT Findings Cardiac CT at 1-month follow-up showing stable device position, appropriate compression (15%), and no device-related thrombus. CT = computed tomography; LA = left atrium; LSPV = left superior pulmonary vein; LV = left ventricle.