Combined pulsed field ablation and left atrial appendage occlusion in a patient with persistent atrial fibrillation and adenomyosis-related menorrhagia: case report and 1-year follow-up.

Background: Pulsed field ablation (PFA) is an emerging modality for atrial fibrillation management, offering rapid pulmonary vein isolation and the possibility of the left atrial posterior wall ablation. Combining PFA with left atrial appendage occlusion (LAAO) represents a holistic strategy for managing heart rhythm abnormalities and minimizing stroke risk, particularly in patients with high thromboembolic and bleeding risks. Case summary: We present a case of a 52-year-old woman with persistent atrial fibrillation, recent percutaneous coronary intervention, and a history of adenomyosis-related menorrhagia, exacerbated by the use of dual antithrombotic therapy. She underwent a single-session PFA and LAAO. The procedure was uncomplicated. At three-month follow-up, imaging confirmed appropriate device placement and complete closure. Anticoagulation was discontinued at three months, and the patient remained asymptomatic at 1-year follow-up while on single antiplatelet therapy. Discussion: This case highlights the feasibility and safety of combining PFA and LAAO in a high-risk patient and underscores the potential for broader adoption in selected populations. Larger studies are needed to evaluate long-term outcomes.