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Peer-reviewedCC BYEuropace : 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

The perspective of combining pulsed field ablation and left atrial appendage closure.

  • Lucas Boersma1
  • Tom De Potter2
  • Christian-Hendrik Heeger3,4
  • Devi Nair5
  • Laurent Roten6
  • Marco Schiavone7
  • Claudio Tondo7,8
  • Pierpaolo Iozzia9
  • Ilaria Giabbani10
  • Mounia Haddad11
  • Kars Neven12,13
13 affiliations
  1. 1Cardiology Department, St. Antonius Hospital Nieuwegein/Amsterdam University Medical Centre, Nieuwegein, the Netherlands.
  2. 2Cardiovascular Research Centre Aalst, AZORG Aalst, Aalst, Belgium.
  3. 3Department of Rhythmology, Asklepios Clinic Altona, Hamburg, Germany.
  4. 4Department of Rhythmology, University of Lübeck, Lubeck, Germany.
  5. 5Department of Cardiac Electrophysiology and Research, St. Bernard's Heart and Vascular Center, Arrhythmia Research Group, Jonesboro, AR, USA.
  6. 6Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
  7. 7Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
  8. 8Department of Surgical, Biomedical and Dental Sciences, University of Milan, Milan, Italy.
  9. 9Customer Education, Boston Scientific EMEA, Milan, Italy.
  10. 10Health Economics and Market Access, Boston Scientific EMEA, Milan, Italy.
  11. 11Medical Affairs, Interventional Cardiology, Boston Scientific Middle East FZ LLC, PO Box 500745, Dubai Science Park, Dubai, United Arab Emirates.
  12. 12Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany.
  13. 13Department of Medicine, Witten/Herdecke University, Witten, Germany.
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Abstract

Pulsed field ablation (PFA) and left atrial appendage closure (LAAC) are increasingly discussed as complementary strategies in atrial fibrillation (AF) care, addressing rhythm control and long-term thromboembolic risk. The rationale is attractive, but the current evidence base is uneven. Randomized evidence for LAAC around AF ablation is strongest for thermal-ablation-era workflows, particularly the OPTION trial, which showed lower non-procedure-related major or clinically relevant non-major bleeding with LAAC than with oral anticoagulation (OAC) and non-inferiority for death, stroke, or systemic embolism. Dedicated PFA-specific evidence remains limited to feasibility studies and early observational experience, and no trial has demonstrated that combined ablation-LAAC procedures are clinically superior when the ablation component is performed with PFA rather than radiofrequency or cryoballoon ablation. In parallel, OAC-withdrawal trials after apparently successful ablation, including OCEAN and ALONE-AF, have reported low thromboembolic event rates in selected lower-risk populations, whereas CLOSURE-AF cautions against simple extrapolation of LAAC benefit to older, frailer patients at high stroke and bleeding risk. This review therefore positions combined PFA-LAAC as a potential option for carefully selected patients rather than an established routine strategy. We summarize procedural workflow, patient selection, trial populations, device-platform considerations, reimbursement and organizational issues, and the main uncertainties that should guide future prospective studies.

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Cite

BibTeXRIS
BibTeX
@article{boersma2026perspective,
  title = {{The perspective of combining pulsed field ablation and left atrial appendage closure.}},
  author = {Lucas Boersma and Tom De Potter and Christian-Hendrik Heeger and Devi Nair and Laurent Roten and Marco Schiavone and Claudio Tondo and Pierpaolo Iozzia and Ilaria Giabbani and Mounia Haddad and Kars Neven},
  journal = {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},
  year = {2026},
  month = oct,
  doi = {10.1093/europace/euag202},
  url = {https://europepmc.org/article/MED/42905909},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - The perspective of combining pulsed field ablation and left atrial appendage closure.
AU  - Lucas Boersma
AU  - Tom De Potter
AU  - Christian-Hendrik Heeger
AU  - Devi Nair
AU  - Laurent Roten
AU  - Marco Schiavone
AU  - Claudio Tondo
AU  - Pierpaolo Iozzia
AU  - Ilaria Giabbani
AU  - Mounia Haddad
AU  - Kars Neven
PY  - 2026
DA  - 2026/10/01
JO  - 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
DO  - 10.1093/europace/euag202
UR  - https://europepmc.org/article/MED/42905909
AB  - Pulsed field ablation (PFA) and left atrial appendage closure (LAAC) are increasingly discussed as complementary strategies in atrial fibrillation (AF) care, addressing rhythm control and long-term thromboembolic risk. The rationale is attractive, but the current evidence base is uneven. Randomized evidence for LAAC around AF ablation is strongest for thermal-ablation-era workflows, particularly the OPTION trial, which showed lower non-procedure-related major or clinically relevant non-major bleeding with LAAC than with oral anticoagulation (OAC) and non-inferiority for death, stroke, or systemic embolism. Dedicated PFA-specific evidence remains limited to feasibility studies and early observational experience, and no trial has demonstrated that combined ablation-LAAC procedures are clinically superior when the ablation component is performed with PFA rather than radiofrequency or cryoballoon ablation. In parallel, OAC-withdrawal trials after apparently successful ablation, including OCEAN and ALONE-AF, have reported low thromboembolic event rates in selected lower-risk populations, whereas CLOSURE-AF cautions against simple extrapolation of LAAC benefit to older, frailer patients at high stroke and bleeding risk. This review therefore positions combined PFA-LAAC as a potential option for carefully selected patients rather than an established routine strategy. We summarize procedural workflow, patient selection, trial populations, device-platform considerations, reimbursement and organizational issues, and the main uncertainties that should guide future prospective studies.
SN  - 1099-5129
SN  - 1532-2092
ER  -