Key result
Pulsed field ablation of the LAA during concomitant LAAC reduced LAA patency at 3-4 months (29% vs 64%; P<0.001) and at 12 months (4% vs 42%; P<0.001) compared to no LAA ablation.
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Why the study?
Left atrial appendage closure is plagued by late peri-device leak, and the impact of stunning the appendage with pulsed field ablation during concomitant procedures on eliminating these leaks was unknown.
Does pulsed field ablation of the left atrial appendage (LAAA) reduce left atrial appendage patency (peri-device leak) in patients undergoing concomitant pulsed field ablation and mechanical left atrial appendage closure?
Observational (n=317)
None (operator discretion; alternating assignment in validation subset)
Yes
Does pulsed field ablation of the left atrial appendage (LAAA) reduce left atrial appendage patency (peri-device leak) in patients undergoing concomitant pulsed field ablation and mechanical left atrial appendage closure?
Absolute Event Rate: 29% vs 64%
p-value: p=<0.001
Concomitant pulsed field ablation of the left atrial appendage during mechanical closure significantly reduces LAA patency and peri-device leak at 3-4 months and 12 months without increasing periprocedural adverse events or device-related thrombus.
BACKGROUND: Left atrial appendage (LAA) closure (LAAC) is plagued by late peri-device leak. We posited that appendage contraction prevents full LAA seal, so conversely, LAA stunning with pulsed field ablation (PFA) of the LAA (left atrial appendage ablation [LAAA]) might promote rapid appendage thrombosis/obliteration. OBJECTIVES: This study aims to assess the impact of LAAA during concomitant procedures on eliminating leaks. METHODS: At 3 centers, consecutive patients undergoing concomitant PFA and LAAC also underwent LAAA or did not undergo LAAA, at operator discretion. Initial (∼3-4 months) (29% transesophageal echocardiography/71% computed tomography) and 12-month imaging were compared with a primary composite outcome of LAA patency, defined as either detectable flow into the LAA or evidence of echo-free space/contrast medium behind the device. RESULTS: Among 317 total patients undergoing PFA and LAAC, including 222 patients who underwent LAAA and 95 who did not (control patients), all underwent initial imaging and 126 reached 12-month imaging follow-up. Device compression was 28% with LAAA vs 25% without LAAA (P < 0.001). Implantation success was 100%. The periprocedural adverse event rate was 2% in both groups. The primary composite outcome of LAA patency was significantly reduced with LAAA vs no-LAAA, both at 3-4 months (29% vs 64%; P < 0.001) and at 12 months (4% vs 42%; P < 0.001). Device-related thrombus rates were low and similar (2.3% vs 3.2%; P = 0.7). A validation subset including only patients with alternating LAAA assignment (LAAA: n = 59; no-LAAA: n = 63) again revealed that LAAA was associated with reduced LAA patency (3-4 months: 34% vs 51%; P = 0.06; 12 months: 8% vs 36%; P = 0.2). Final LAA e' velocity was significantly different between groups (17 ± 7 vs 34 ± 16 cm/s; P < 0.001), with higher velocity associated with LAA patency (P < 0.001). CONCLUSIONS: PFA of the LAA has potential to reduce LAA patency during device-based LAAC.
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Power et al. (2026) conducted an observational in Atrial fibrillation undergoing concomitant pulsed field ablation and left atrial appendage closure (n=317). Pulsed field ablation of the left atrial appendage (LAAA) prior to LAAC vs. Concomitant PFA and LAAC without LAAA was evaluated on Composite of LAA patency (detectable flow into the LAA or evidence of echo-free space/contrast medium behind the device) at 3-4 months (p=<0.001). Pulsed field ablation of the LAA during concomitant LAAC reduced LAA patency at 3-4 months (29% vs 64%; P<0.001) and at 12 months (4% vs 42%; P<0.001) compared to no LAA ablation.
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