Combined Direct Current Cardioversion and Left Atrial Appendage Occlusion in Patients With Contraindication to Anticoagulation: A Single-Center Feasibility Study.

Background: Direct current cardioversion (DCCV) for atrial fibrillation is typically followed by 3 to 4 weeks of oral anticoagulation (OAC) because of atrial stunning and thromboembolic risk, which some patients cannot tolerate. Left atrial appendage occlusion (LAAO) provides an OAC-sparing alternative, but the feasibility of performing DCCV immediately before LAAO has not been well defined. Methods: We conducted a retrospective single-center study of consecutive patients with atrial fibrillation with relative or absolute contraindications to post-cardioversion OAC who underwent planned DCCV immediately followed by percutaneous LAAO using Watchman FLX or FLX Pro devices. Procedural characteristics, in-hospital outcomes, follow-up imaging findings, and clinical outcomes at 45 days, 3 months, and 1 year were assessed using cardiac computed tomography or transesophageal echocardiography. Results: Twelve patients underwent concomitant DCCV + LAAO (mean age 75 ± 9 years; 33% women). Bleeding history was present in 67%, with mean CHA Conclusions: In this pilot series, a combined DCCV + LAAO strategy was feasible and not associated with excess thromboembolic or bleeding events. Early and intermediate outcomes were comparable to contemporary standalone LAAO experience. Larger prospective studies are needed to further evaluate this OAC-sparing approach.