Recommended Citation
Shereef H, Erickson L, Fischer GJ, Kanani J, Sra J. Institutional Experience of Concomitant Atrial Fibrillation Ablation and Left Atrial Appendage Occlusion. Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Abstract
Background/Significance:
Catheter ablation is a class 1 indication for treatment of symptomatic atrial fibrillation (AF). Left atrial appendage occlusion (LAAO) is an alternative option to anticoagulation in patients with AF and a contraindication to long-term anticoagulation. Combining catheter ablation and LAAO in a single procedure, referred to as the concomitant procedure, has emerged as a strategy for management of AF.
Purpose:
To assess the efficacy and safety of the concomitant procedure at a single center.
Methods:
In this retrospective observational study, data were collected on 28 patients who underwent LAAO with either the WATCHMAN FLX-PRO (n=26) or the Amplatzer Amulet device (n=2) concomitant with pulsed field ablation (PFA) from October 2024 to March 2025. Fluoroscopy was used in addition to transesophageal echocardiography (TEE) and/or intracardiac echocardiography for transseptal puncture and LAAO implantation. Left atrial appendage measurements were made prior to AF ablation to avoid measurement bias caused by edema from AF ablation. Efficacy was defined as complete pulmonary vein isolation (PVI), successful implantation of LAAO device, and < 3 mm residual LAAO leak at 45-day post-procedural imaging.
Results:
The study cohort average age was (72.6 ± 5.2 years), 28.6% were females and 96.4% were White; the average CHA2DS2VASc (1.57 ± 0.74) and HAS-BLED (1.96 ± 1.04) scores were calculated; the average body mass index was (31.1 ± 6.13 kg/m2). AF was classified as paroxysmal in 67.9%, persistent in 28.6% and long standing persistent in 3.5%. All patients had successful PVI. Device implantation was successful with the initial attempt in 27 (96.4%) patients;1 patient required resizing. Median procedure time was 151.9 (118, 164) min, median fluoroscopy time 34.0 (28.8, 47.0) min, and median left atrial dwell time 104 (82.5, 119) min. Of 19 patients with post-procedural TEE, 11 (57.9%) patients had < 1 mm peri-device leak, 4 (21.1%) patients had a residual leak of 1- 3 mm leak, and 4 (21.1%) patients had a residual leak of ≥ 3 mm. Post-procedure, 2 (7.1%) patients had minor bleeding, and 1 (3.6%) patient had a pericardial effusion which did not require intervention.
Conclusion:
Concomitant catheter ablation of AF and LAAO was feasible in our study cohort, demonstrating 100% acute PVI and minimal complications. Larger cohort studies with longer follow-up periods are needed to report patient safety and optimize outcomes.
Presentation Notes
Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Full Text of Presentation
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Document Type
Oral/Podium Presentation
Institutional Experience of Concomitant Atrial Fibrillation Ablation and Left Atrial Appendage Occlusion
Background/Significance:
Catheter ablation is a class 1 indication for treatment of symptomatic atrial fibrillation (AF). Left atrial appendage occlusion (LAAO) is an alternative option to anticoagulation in patients with AF and a contraindication to long-term anticoagulation. Combining catheter ablation and LAAO in a single procedure, referred to as the concomitant procedure, has emerged as a strategy for management of AF.
Purpose:
To assess the efficacy and safety of the concomitant procedure at a single center.
Methods:
In this retrospective observational study, data were collected on 28 patients who underwent LAAO with either the WATCHMAN FLX-PRO (n=26) or the Amplatzer Amulet device (n=2) concomitant with pulsed field ablation (PFA) from October 2024 to March 2025. Fluoroscopy was used in addition to transesophageal echocardiography (TEE) and/or intracardiac echocardiography for transseptal puncture and LAAO implantation. Left atrial appendage measurements were made prior to AF ablation to avoid measurement bias caused by edema from AF ablation. Efficacy was defined as complete pulmonary vein isolation (PVI), successful implantation of LAAO device, and < 3 mm residual LAAO leak at 45-day post-procedural imaging.
Results:
The study cohort average age was (72.6 ± 5.2 years), 28.6% were females and 96.4% were White; the average CHA2DS2VASc (1.57 ± 0.74) and HAS-BLED (1.96 ± 1.04) scores were calculated; the average body mass index was (31.1 ± 6.13 kg/m2). AF was classified as paroxysmal in 67.9%, persistent in 28.6% and long standing persistent in 3.5%. All patients had successful PVI. Device implantation was successful with the initial attempt in 27 (96.4%) patients;1 patient required resizing. Median procedure time was 151.9 (118, 164) min, median fluoroscopy time 34.0 (28.8, 47.0) min, and median left atrial dwell time 104 (82.5, 119) min. Of 19 patients with post-procedural TEE, 11 (57.9%) patients had < 1 mm peri-device leak, 4 (21.1%) patients had a residual leak of 1- 3 mm leak, and 4 (21.1%) patients had a residual leak of ≥ 3 mm. Post-procedure, 2 (7.1%) patients had minor bleeding, and 1 (3.6%) patient had a pericardial effusion which did not require intervention.
Conclusion:
Concomitant catheter ablation of AF and LAAO was feasible in our study cohort, demonstrating 100% acute PVI and minimal complications. Larger cohort studies with longer follow-up periods are needed to report patient safety and optimize outcomes.
Affiliations
Aurora Sinai Medical Center, Aurora St. Luke’s Medical Center