Cryoballoon pulmonary vein isolation and voltage mapping for symptomatic atrial fibrillation 9 months after Watchman device implantation

Left atrial appendage occlusion (LAAO) with the Watchman device (Boston Scientific, Natick, MA) is frequently performed as a nonpharmacologic, second-line therapy for stroke prevention in patients with atrial fibrillation (AF)1, 2 and contraindications to long-term anticoagulation. Although combined catheter pulmonary vein isolation (PVI) and Watchman procedures may be performed successfully for patients with symptomatic AF, a simultaneous approach is not always feasible or in some cases PVI may not be clinically indicated at the time of Watchman implantation. Staged radiofrequency PVI and left atrial (LA) catheter ablation following Watchman device placement has been shown to be feasible3, 4, 5; however, other modalities for PVI have not been reported in the postimplant population.