Totally thoracoscopic concomitant left atrial appendage closure and left ventricular epicardial lead implantation

Atrial fibrillation in patients with heart failure due to ventricular dyssynchrony needs decision-making on the rate and rhythm control strategies together with cardiac resynchronization therapy and antithrombotic prophylaxis. Transvenous biventricular pacing and percutaneous appendage closure in patients with heart failure and atrial fibrillation with high bleeding risk are valid therapeutic options but anatomical exclusion criteria could be present. Here, we report two patients who underwent successful totally thoracoscopic concomitant left appendage occlusion and epicardial left ventricular lead implantation.