WESTERN AFIB 2026 SESSION

Session 11 Roundtable: My Indication for Concomitant LAAO With AF Ablation

11/02/2026

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Edited by Jodie Elrod

Featured is the Session 11 Roundtable entitled "My Indication for Concomitant LAAO With AF Ablation," from Western AFib 2026. With Dhanunjaya Lakkireddy MD, MBA (moderator) and panelists James V. Freeman, MD, MPH, MS; John Mandrola, MD; Oussama Wazni, MD; Dan Leslie Li, MD; Edip Gurol, MD, MSc; and Jeff Healey, MD.

Clinical Summary

Concomitant AF Ablation and Left Atrial Appendage Closure: Several panelists favored concomitant ablation and left atrial appendage closure when patients independently qualify for both procedures. Data from the Yale New Haven Health System showed 40% of 12,000 patients with a primary or secondary diagnosis of AF and CHA₂DS₂-VASc score of 2 or greater were not receiving anticoagulation.
OPTION, OCEAN, and ALONE: Panelists disputed whether evidence supports routine concomitant closure. OCEAN and ALONE evaluated anticoagulation withdrawal after successful ablation; their selected populations do not establish ablation as a substitute for anticoagulation before procedural success is known. Low-risk patients were generally considered poor candidates for concomitant closure.
Pulsed field ablation and Watchman: A 2025 three-center Hong Kong study described ridge edema, altered appendage ostial measurements, and follow-up peridevice leak. Discussion emphasized closure durability, device-related thrombus, possible repeat ablation, and individualized assessment before combining procedures.