# Pulsed-Field Ablation With Transcatheter Left Atrial Appendage Occlusion for Left Atrial Appendage–Origin Atrial Tachycardia

## TL;DR

Combining pulsed-field ablation with left atrial appendage occlusion is a feasible treatment for a specific type of heart rhythm disorder.

## Contribution

The study demonstrates the feasibility of combining PFA with LAAO for LAA-origin atrial tachycardia.

## Key findings

- PFA can cause significant edema in the left atrial appendage.
- Device overcompression based on pre-PFA imaging ensures durable LAA sealing.
- Concomitant PFA and LAAO is a viable treatment strategy for LAA-origin AT.

## Abstract

Pulsed-field ablation (PFA) may be an emerging treatment for left atrial appendage (LAA)–origin atrial tachycardia (AT), but it may cause thrombus in the LAA. Concomitant transcatheter LAA occlusion (LAAO) may address this risk.

A 54-year-old man with symptomatic LAA-origin AT underwent PFA. Post-PFA transesophageal echocardiography showed significant pectinate muscle edema with narrowing of the LAA orifice. To avoid late peridevice leak, a 40-mm Watchman FLX Pro (Boston Scientific) was implanted with intentional overcompression. At the 1-month follow-up, cardiac computed tomography demonstrated a complete LAA seal with adequate device compression.

Concomitant PFA and LAAO is feasible for LAA-origin AT. Because PFA can induce significant edema within the LAA, device selection based on pre-PFA imaging is critical to ensure durable sealing.

Careful pre-PFA imaging-based device sizing is critical when combining PFA with LAAO in patients with LAA-origin AT.