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Updated: Jun 25, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Pulsed field ablation in patients with a prior left atrial appendage closure device and concomitant leak closure
Vincenzo Mirco La Fazia1, Marco Marino2, Emanuele Chiarazzo2
1Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, Texas; Department of Experimental Medicine, Tor Vergata University, Rome, Italy.
Background:
Pulsed field ablation (PFA) has emerged as a nonthermal alternative for catheter ablation of atrial fibrillation (AF). However, experience on ablation in patients with a prior left atrial appendage occlusion (LAAO) device remains limited.
Objective:
This study aimed to assess the feasibility and safety of PFA in patients with an implanted LAAO device and evaluate outcomes in those undergoing a combined PFA and leak closure procedure.
Methods:
We analyzed consecutive patients with a prior LAAO device who underwent PFA alone or a concomitant leak closure procedure for symptomatic AF. The primary endpoints were procedural success, defined as successful PFA delivery, and safety, defined as the absence of device dislodgment, new peridevice leaks (PDLs), and device-related thrombus (DRT).
Results:
73 consecutive patients were included in our analysis. PFA was performed using the Farapulse and Affera systems in 45 (61.6%) and 28 (38.4%) patients, respectively. Concomitant PDL closure was performed in 18 patients (24.6%). The combined procedural endpoint was achieved in 70 patients (95.9%). At 2-month transoesophageal echocardiography follow-up, no new PDLs, device-related thrombus, or dislodgment were detected in patients undergoing PFA alone, whereas 2 patients (11.1%) in the combined procedure group had residual leaks. The use of radiofrequency was necessary in 3 patients with an Amulet device to isolate the LAA.
Conclusion:
Our findings suggest that PFA in patients with an implanted LAAO device is feasible. The combined approach of PFA and leak closure demonstrated high procedural efficacy.
