Related Experiment Video
Updated: May 23, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Focal Pulsed Field Ablation and Strategic Upsizing in Concomitant Atrial Fibrillation Ablation and Left Atrial
Tesfatsiyon Ergando1, Mariam Tarek Desouki2, Mathew Katsiyiannis2
1Minneapolis Heart Institute, Minneapolis, Minnesota, USA; Hennepin Health, Minneapolis, Minnesota, USA.
Background:
Concomitant atrial fibrillation ablation and left atrial appendage (LAA) occlusion are increasingly considered in patients with elevated thromboembolism and bleeding risk. Emerging data suggest a higher incidence of peridevice leak with pulsed field ablation (PFA).
Case Summary:
Two patients underwent concomitant PFA with the Sphere-9 catheter (Affera/Medtronic) and Watchman FLX Pro (Boston Scientific); postablation LAA changes were managed with tailored upsizing in one case and standard sizing in the other. At 6 months, both maintained sinus rhythm on antiplatelet therapy with no thromboembolic or bleeding events, and cardiac computed tomography confirmed well-seated devices with peridevice leak ≤2 mm.
Discussion:
These are the first reported cases of concomitant LAA occlusion with Watchman FLX Pro and Sphere-9 PFA. Postablation LAA anatomical changes influenced device selection, and larger studies are needed to validate these findings.
Take-Home Messages:
Focal PFA led to specific, observable changes in LAA anatomy, directly affecting device sizing decisions. Tailoring device sizing to account for postablation LAA remodeling-using standard sizing or upsizing-may optimize device seal and compression.
