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

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Atrial fibrillation treatment often involves left atrial appendage occlusion (LAAO) and pulmonary vein isolation (PVI) via pulsed field ablation (PFA).
• Combining PFA and LAAO into a single procedure is a promising strategy for improving patient outcomes.

Purpose of the Study:

• To compare the efficacy and safety of combined PFA and LAAO procedures versus standalone PFA or LAAO procedures.
• To evaluate outcomes such as pulmonary vein isolation, LAAO success, and peridevice leak (PDL).

Main Methods:

• A retrospective cohort study involving 36 patients undergoing combined PFA and LAAO, compared with standalone LAAO (48 patients) and standalone PFA (52 patients) groups.
• PFA utilized the Farapulse system, followed by WATCHMAN FLX LAAO implantation, with pulmonary ridge thickness measured before and after ablation.
• Occlusion success and significant PDL (>3 mm) were assessed at 3 months using TEE or CT.

Main Results:

• Acute PVI was achieved in all combined and PFA groups; successful LAAO implantation was high (97.2% combined, 100% standalone).
• A significant mean increase of 69.4% in pulmonary ridge thickness was observed immediately after PFA in the combined group.
• While overall PDL rates were similar, significant PDL occurred more frequently in the combined group (20%) compared to the standalone LAAO group (2.2%, P=.013).

Conclusions:

• Combined PFA and LAAO is a feasible approach for atrial fibrillation management.
• The procedure leads to a notable increase in pulmonary ridge thickness post-ablation.
• There is a higher prevalence of significant peridevice leak in patients undergoing the combined procedure, warranting further investigation.