Chaired by Devi Nair (Jonesboro, US), this live case from CCB Markus Krankenhaus, Frankfurt, featured Julian Chun, Boris Schmidt and Stefano Bordignon performing a combined left atrial appendage (LAA) closure and pulsed field ablation (PFA) pulmonary vein isolation (PVI) for a 76-year-old patient with persistent atrial fibrillation (AF) and a CHA₂DS₂-VASc score of 3. The patient, intolerant to oral anticoagulation, underwent LAA closure first using a 24 mm Watchman FLX device, followed by PFA PVI using the FARAPULSE catheter. The panel, including Serge Boveda (Toulouse, FR) and Julia Vogler (Lubeck, DE), discussed procedural sequencing, transseptal puncture positioning and device sizing considerations, highlighting the importance of careful planning to prevent peri-device leaks.

The discussion addressed whether to perform PVI or LAA closure first, considering the potential for post-PFA swelling to impact device positioning. The case operators demonstrated multiple deployment adjustments before achieving optimal Watchman FLX placement. The session concluded with an efficient PFA PVI, following the Frankfurt-modified protocol of 10 applications per vein to enhance durability. This expertly executed case showcased precise procedural techniques, advanced imaging integration and a structured workflow for safe and effective concomitant LAA closure and PFA PVI.