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

Year: 2026

Type: article

Abstract: BACKGROUND: 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. CASE SUMMARY: 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. DISCUSSION: 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. TAKE-HOME MESSAGES: Careful pre-PFA imaging-based device sizing is critical when combining PFA with LAAO in patients with LAA-origin AT.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2026.106879