Combined pulsed field ablation and left atrial appendage occlusion: A multicenter comparative study

Abstract

Background: Combining pulsed field ablation (PFA) and left atrial appendage occlusion (LAAO) to 1 procedure is appealing for the treatment of atrial fibrillation.

Objective: This study aimed to compare the outcome of combined and standalone procedures.

Methods: This is a retrospective cohort study of consecutive patients undergoing combined PFA and LAAO procedures in 3 centers in 2023. They underwent PFA pulmonary vein isolation (PVI) with Farapulse (Boston Scientific, Marlborough, MA), followed by LAAO with WATCHMAN FLX (Boston Scientific) guided by transesophageal echocardiogram (TEE). Pulmonary ridge thickness was measured at 45 degrees, 5 mm from tip of the ridge, before and after PFA. At 3 months, TEE or computed tomography was performed for patients with LAAO to assess occlusion results. Peridevice leak (PDL) of more than 3 mm was defined as significant. Consecutive PFA or LAAO standalone procedures served as controls.

Results: This cohort included 36 combined, 48 standalone LAAO, and 52 standalone PFA cases. Acute PVI was achieved in all combined and PFA standalone procedures. Successful LAAO implantation with WATCHMAN FLX was achieved in 97.2% combined procedures and all standalone LAAO procedures. In the combined cohort, pulmonary ridge thickness increased after ablation by 2.72 ± 1.19 mm (P < .001) or 69.4% ± 51.4%. At 3 months, the rate of PDL did not differ between combined and standalone LAAO cohorts (26.7 vs 15.2%, P = .22). However, significant PDL (> 3 mm) occurred more commonly in the combined cohort compared with the standalone LAAO cohort (20% vs 2.2%, P = .013).

Conclusion: Combined PFA and LAAO was feasible. However, we observed a mean 69.4% increase in pulmonary ridge thickness immediately following PFA. Significant PDL was more prevalent in combined procedure.

Keywords: Atrial fibrillation ablation; Combined procedures; Farapulse; Left atrial appendage occlusion; Peridevice leak; Pulsed field ablation; WATCHMAN.