Abstract

Clinical significance of left atrial appendage edema and dense spontaneous echo contrast after pulsed field ablation with planned concomitant device closure

Author(s): Muhammad Munawar, Evan J. Gunawan, Jefri Lim, Dian L. Munawar, Firman Tedjasukmana, Dian A. Munawar, Beny Hartono

Pulsed Field Ablation (PFA) is an emerging non-thermal ablation modality that achieves selective myocardial injury while preserving adjacent non-cardiac structures. Its rapid energy delivery and favourable safety profile make it a promising candidate for integration with Left Atrial Appendage Closure (LAAC) in a single procedural session. This combined approach offers a comprehensive strategy addressing both rhythm control and stroke prevention in atrial fibrillation management. However, Transient Left Atrial Appendage (LAA) edema and Spontaneous Echo Contrast (SEC) may occur after PFA, leading to temporary alterations in LAA geometry, flow velocity, and imaging interpretation. Consequently, the feasibility and safety of concomitant pulmonary vein isolation and LAAC using PFA remain under active investigation. Although these tissue changes are typically self-limiting, they underscore the importance of meticulous procedural anticoagulation and careful imaging evaluation. Further studies are warranted to clarify their temporal evolution, clinical relevance, and implications for optimizing combined PFA-LAAC strategies.