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Updated: Oct 25, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Pulsed Field Ablation of the Left Atrial Appendage Before Mechanical Closure to Reduce Peri-Device Leak (STUN-AF)
John R Power1, Devi G Nair2, Shephal K Doshi3
1Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Background:
Left atrial appendage (LAA) closure (LAAC) is plagued by late peri-device leak. We posited that appendage contraction prevents full LAA seal, so conversely, LAA stunning with pulsed field ablation (PFA) of the LAA (left atrial appendage ablation [LAAA]) might promote rapid appendage thrombosis/obliteration.
Objectives:
This study aims to assess the impact of LAAA during concomitant procedures on eliminating leaks.
Methods:
At 3 centers, consecutive patients undergoing concomitant PFA and LAAC also underwent LAAA or did not undergo LAAA, at operator discretion. Initial (∼3-4 months) (29% transesophageal echocardiography/71% computed tomography) and 12-month imaging were compared with a primary composite outcome of LAA patency, defined as either detectable flow into the LAA or evidence of echo-free space/contrast medium behind the device.
Results:
Among 317 total patients undergoing PFA and LAAC, including 222 patients who underwent LAAA and 95 who did not (control patients), all underwent initial imaging and 126 reached 12-month imaging follow-up. Device compression was 28% with LAAA vs 25% without LAAA (P < 0.001). Implantation success was 100%. The periprocedural adverse event rate was 2% in both groups. The primary composite outcome of LAA patency was significantly reduced with LAAA vs no-LAAA, both at 3-4 months (29% vs 64%; P < 0.001) and at 12 months (4% vs 42%; P < 0.001). Device-related thrombus rates were low and similar (2.3% vs 3.2%; P = 0.7). A validation subset including only patients with alternating LAAA assignment (LAAA: n = 59; no-LAAA: n = 63) again revealed that LAAA was associated with reduced LAA patency (3-4 months: 34% vs 51%; P = 0.06; 12 months: 8% vs 36%; P = 0.2). Final LAA e' velocity was significantly different between groups (17 ± 7 vs 34 ± 16 cm/s; P < 0.001), with higher velocity associated with LAA patency (P < 0.001).
Conclusions:
PFA of the LAA has potential to reduce LAA patency during device-based LAAC.
