Over-the-Wire PFA Loop Catheter and LAAO Concomitant Procedure | RIO 2024 US Focus

Chair Bradley Knight (Chicago, US) led a session on over-the-wire pulse field ablation (PFA) using a loop catheter alongside a concomitant left atrial appendage closure (LAAC) procedure. Case operator Usman Siddiqui (Orlando, US) demonstrated the procedure, with expert panellists Andrea Natale (Austin, US) and Nitesh Sood (Boston, US) providing insights. The discussion covered the Pulse Select PFA system, which features a 25 mm loop with a 20° forward tilt for improved contact. The session highlighted the importance of high-definition mapping, contact verification via intracardiac echocardiography (ICE), and lesion quality assessment. The faculty also discussed PFA’s safety advantages, including reduced risk of pulmonary vein stenosis and haemodynamic instability. The LAAC segment focused on dual-seal closure using the Amulet device. Siddiqui explained key considerations, including transeptal puncture location and imaging for accurate device placement. The team discussed integrating ICE and fluoroscopy to confirm positioning and mitigate complications. Panellists emphasised procedural planning, ensuring optimal left atrial appendage occlusion without impeding mitral valve function. The session concluded with a review of workflow efficiency and best practices for managing concomitant PFA and LAAC procedures.