Percutaneous left atrial appendage occlusion can impair pulmonary vein isolation with pulse field ablation

Abstract

Abstract Background Pulsed-field ablation (PFA) is a promising new ablation modality for pulmonary vein isolation (PVI). However, the feasibility in the presence of a percutaneous left atrial appendage occluder (LAAO) has not yet been investigated. We observed that PFA applications in the left pulmonary veins after LAAO can be interrupted. The aim of this analysis was to investigate the feasibility of PFA with a single-shot device for PVI after LAAO. Methods / Results: Retrospective multicenter analysis. A total of 16 patients (male 81.3%, mean age 71.6 +/-7.4) underwent PVI with PFA after LAAO at 5 different centers in Switzerland and Germany, from August 2021 until July 2023. In 5 patients PFA application at the left-sided PVs was aborted due to interference with the LAAO (Figure). In one patient, the left superior PV could be isolated by repositioning the PFA catheter, in 2 cases successful PVI was achieved after switching to radiofrequency ablation, and in 2 cases the respective left sided PV was not isolated. In all 5 patients the LAAO was an Amplatzer Amulet device (Amplatzer Amulet vs. other LAAO, p=0.069). Mean LAAO size was not significantly different among both groups. Conclusions LAAO can interfere with PFA applications around the left superior pulmonary vein. This effect may be associated with the design of the LAAO.