Case report: A unified CTA-fluoroscopy roadmap for single-session pulsed field ablation and left atrial appendage...

Single-session pulsed field ablation (PFA) and left atrial appendage occlusion (LAAO) is a clinically attractive strategy for selected patients with atrial fibrillation who require both rhythm-control therapy and stroke-prevention intervention. However, the combined procedure requires the operator to maintain spatial orientation while moving from transseptal access to pulmonary vein targeting and then to appendage engagement and device deployment. In this retrospective, single-centre technical case series, we evaluated five consecutive patients undergoing single-session PFA and LAAO with computed tomography angiography (CTA)-fluoroscopy fusion as a unified anatomical roadmap. Pre-procedural CTA was registered to intraoperative DynaCT, and a simplified CTA-derived model of the left atrium, pulmonary veins, superior vena cava, interatrial septum, and left atrial appendage was overlaid on live fluoroscopy. The same registered roadmap was intended to be retained across transseptal access, PFA localization, and LAAO deployment. The workflow was fully implemented in four patients and interrupted in one because of workflow-related factors during early adoption. PFA and WATCHMAN implantation were completed in all patients. At 45-day CTA follow-up, no residual leak or device-related thrombus was observed. Quantitative registration error and component-specific image-processing times were not prospectively recorded, and no conventional-guidance comparator was available. This proof-of-concept case series demonstrates the feasibility of translating pre-procedural CTA planning into a retained intraprocedural fluoroscopic roadmap across the electrophysiological and structural phases of a single-session intervention.