Concomitant PFA-based AF ablation and LAA closure proved to be feasible, effective, and safe with an overall short procedure duration in a large multicentre study.
The combined procedure of PFA-based pulmonary vein isolation and left atrial appendage closure achieved the primary efficacy endpoint in 97.4% of patients.
The primary safety endpoint of serious adverse events occurred in a low proportion of patients.
Peri-device gaps were detected in a minority of patients at follow-up imaging.
The majority of patients with available arrhythmia follow-up beyond 6 months were in sinus rhythm.
The combined PFA-based PVI and LAAC procedure was associated with a short overall procedure duration.
This research suggests that two heart procedures — catheter ablation for atrial fibrillation (AF) using a newer technology called pulsed field ablation (PFA), and closure of the left atrial appendage (a small pouch in the heart where blood clots often form in AF patients) — can be safely and effectively performed together in a single session. The study enrolled 155 patients across 22 hospitals in nine European countries. Because both procedures require entering the heart through the same blood vessel, combining them into one session is a logical approach that could reduce the burden on patients compared to having two separate procedures. The combined procedure was highly successful: all patients had their pulmonary veins successfully isolated (the goal of AF ablation), and 97.4% had successful closure of their left atrial appendage. Serious complications were rare, occurring in fewer than 2% of patients. Follow-up imaging showed no devices had moved out of place and no blood clots had formed on the closure devices. After more than 6 months of follow-up, over three-quarters of patients were in normal heart rhythm. This research suggests that combining PFA-based AF ablation with left atrial appendage closure is a practical, effective, and safe option for carefully selected AF patients who need both interventions. The findings are particularly relevant for patients at high stroke risk who might benefit from appendage closure in addition to ablation, as doing both in one procedure could mean less time under anesthesia, fewer hospital visits, and a quicker return to normal life. Larger prospective studies will be needed to confirm these results.
Heeger C, Roten L, Della Rocca D, Velagić V, Gupta D, De Potter T, et al.. (2026). COnCOmitaNt pulsed field ablation-based pUlmonary vein isolation and lefT atrial appendage closure: the COCONUT study.. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. https://doi.org/10.1093/europace/euag198