Durable LAA isolation combining pulsed field ablation and radiofrequency linear lesions in a patient with a therapy refractory left atrial appendage tachycardia

Background: Treating atrial tachycardia (AT) originating from left atrial appendage (LAA) needs sometimes electrical isolation of LAA. We report a case of AT originating from LAA successfully treated with electrical isolation using the novel lattice-tip pulsed-field/radiofrequency ablation (PFA/RFA) catheter. A 55-year-old female patient with a history of three focal ablative attempts for a highly symptomatic AT originating from the LAA in different centers was admitted to our department for the recurrence of the clinical tachycardia. Electrical isolation of the LAA (LAAEI) was successfully performed with a lattice-tip PFA/RFA ablation catheter. Six weeks after the procedure, an invasive re-mapping study indicated a durable electrical LAA isolation; therefore, a 24-mm-sized LAA occlusion device (WATCHMAN FLX device, Boston Scientific, Plymouth, MN, USA) was implanted.

Discussion: In this case, we successfully treated an atrial tachycardia originating from LAA using the recently approved lattice-tip PFA/RFA ablation catheter. The combination between two energy sources during the same procedure could potentially improve lesions transmurality offering a new promising solution for the treatment of complex atrial tachycardias.