Dr Amr Nawar (Sultan Qaboos University Hospital, Muscat, OM) walks through a concomitant pulmonary vein isolation (PVI) and left atrial appendage (LAA) closure procedure in a single 90-minute session — treating the arrhythmia and addressing embolic risk simultaneously.

The case centres on a 70-year-old male with atrial fibrillation and a history of two transient ischaemic attacks. Dr Nawar details his step-by-step approach to combining pulsed field ablation (PFA) using the Farapulse Farawave Nav catheter with Watchman FLX implantation — and the practical decision-making that underpins a safe, efficient one-stop workflow.

Key procedural insights include the eight-application PFA protocol for secure pulmonary vein lesions, device sizing considerations in the context of post-ablation oedema, stability confirmation via TEE, and techniques for preventing air embolism during sheath exchanges under conscious sedation. Dr Nawar also contextualises the approach within the OPTION trial data, supporting the non-inferiority of concomitant PVI and LAA closure versus oral anticoagulation — with a favourable safety profile.

The patient was discharged the same day, off anticoagulation, and free of atrial fibrillation.

Editor: Jordan Rance
Videographer: David Ben-Harosh
Support: This is an independent production by Radcliffe Cardiology for Arrhythmia Academy.