Comprehensive AF Management | RIO 2024 US Focus

Chair Bradley Knight (Chicago, US) led a session on comprehensive atrial fibrillation (AF) management, featuring case operator Devi Nair (Jonesboro, US) and panellists Mohit Turagam (New York, US) and Oussama Wazni (Cleveland, US). The session highlighted a concomitant procedure combining pulmonary vein isolation (PVI) using the Farawave PFA catheter with an integrated mapping solution and left atrial appendage (LAA) closure using the WATCHMAN Flex Pro device. The case involved a 78-year-old woman with coronary artery disease, recurrent gastrointestinal bleeds, and paroxysmal AF on amiodarone. A CT-guided approach was used to assess anatomy, ensuring precise lesion placement. The PFA workflow focused on optimising contact with real-time mapping, and ice-guided catheter positioning was crucial for procedural accuracy. The panel discussed procedural efficiencies, including fluoroscopy-free techniques, mapping strategies, and the impact of oedema on LAA closure device deployment. Debbie Nair emphasised the importance of performing PVI before LAA closure to avoid procedural interference and compression changes. The WATCHMAN Flex Pro device was deployed using a steerable sheath for optimal placement, with verification through echocardiography and contrast angiography. The session concluded with a discussion on anticoagulation strategies, procedural best practices, and device interactions, reinforcing the importance of workflow refinement in concomitant PFA and LAA closure.