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Updated: May 7, 2026

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
28:13

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

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

Mark T K Tam1, Pipin Kojodjojo2, Yat-Yin Lam3

  • 1The Chinese University of Hong Kong, Hong Kong; Prince of Wales Hospital, Hong Kong.

Heart Rhythm
|March 23, 2025
PubMed

Insights

Combining pulsed field ablation (PFA) with left atrial appendage occlusion (LAAO) is feasible but increases the risk of significant peridevice leak. Further research is needed to optimize this combined approach for atrial fibrillation treatment.

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.
Abstract

Keywords:
Atrial fibrillation ablationCombined proceduresFarapulseLeft atrial appendage occlusionPeridevice leakPulsed field ablationWATCHMAN

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