Chair Richard Schilling (London, UK) led a discussion on a combined pulmonary vein isolation (PVI) and left atrial appendage closure (LAAC) procedure using pulsed field ablation (PFA). Case operators Julian Chun, Boris Schmidt, and Stefano Bordignon (CCB Markus Krankenhaus, Frankfurt, DE) performed the live case, while panelists Andreas Metzner (Hamburg, DE), Devi Nair (Jonesboro, US), and Arian Sultan (Cologne, DE) provided insights into catheter selection, procedural techniques, and anticoagulation strategies.

The discussion focused on optimising PVI using the Farawave PFA system and ensuring effective LAAC with the Watchman Flex device. The faculty debated catheter sizing for large pulmonary veins, the impact of oedema on LAAC measurements, and best practices for transseptal puncture placement. They also explored the evolving role of PFA in AF treatment, durability concerns, and future research on anticoagulation strategies post-LAAC, referencing ongoing trials assessing stroke prevention in high-risk patients.