Safety and feasibility of pulsed field ablation in patients with a prior left atrial appendage closure device

Background Experience on pulsed field ablation (PFA) in patients with a prior left atrial appendage (LAA) occlusion device is limited. Purpose This study aimed to assess the feasibility and safety of PFA in patients with an implanted LAA occlusion device. Methods We analyzed 73 consecutive patients with a prior LAA occlusion device who underwent PFA with either pentaspline and lattice tip catheters system between February 2024 and September 2025. The efficacy endpoint was defined as successful isolation of left pulmonary veins (PV) or of the LAA, while the safety endpoint included system shortage due to EMI and new peri-device leaks (PDLs), device-related thrombus (DRT) during follow-up. Results PFA was performed using the pentaspline and lattice tip catheters in 45 (61.6%) and 28 (38.4%) respectively. The efficacy endpoint was achieved in all during PVs isolation. LAA isolation was successfully performed in 5 patients using the pentasline catheters and in 15 patients using the lattice tip catheters. However, during LAA isolation, in the pentaspline group, EMI prevented energy delivery in 3(60%) patients, while in the lattice tip group, bubble formation related to energy delivery shortage occurred in 3(20%) patients; upon removal of the lattice tip catheters from the left atrium, fibrin deposition was observed in 2 of these cases. At 3-months transoesophageal echocardiography follow-up, no new PDLs or DRT were detected. Conclusion Our findings suggest that PFA in patients with an implanted LAA occlusion device is safe and feasible. However, attention should be paid to system shortages, as, in rare cases, this can result in fibrin apposition.