Results

The combined procedure cohort comprised 54.7% male, with a median age of 67 years. Half of the cohort was diagnosed with persistent AF. Relatively high risks of stroke (median CHA2DS2-VASc score=3) and bleeding (median HAS-BLED score=2) can be observed (Table 1 ). Instant pulmonary vein isolation (PVI) was achieved in 117 patients, while LAAC with Watchman device failed in 2 patients who had oversized LAA ostium. During procedure, totally 9 patients, 7 with Watchman and 2 with LAmbre, required redeployment. Instant minimal residual flow was observed in 2 patients with Watchman device (Figure 3 A & B) . No other complications occurred. Procedure details are listed inTable 2 .
For 96 patients with available TEE image series, acute LAR lesion was observed via TEE in almost every patient (99.0%). TEE measurement showed that LAR had a greater increase in width (Δwidth=3.6±2.3 mm, 45°) than thickness (Δthickness=2.6±3.5 mm, 45°). Correspondingly, the outer ostium was significantly narrowed (Δouter ostium diameter=-3.4±4.0 mm, 45°). However, the inner ostium remained unchanged (Δinner ostium diameter=0.4±2.2 mm, 45°). During follow-up, the lesion subsided and LAR recovered to its original width but not thickness. The LAR profile is depicted in Figure 2. Analysis of the association of LAR lesion size with multiple variables showed that, only LSPV nadir temperature positively correlated with over 2-fold wider LAR lesion at 45° (crude odds ratio (OR)=1.12, 95% confidence interval (CI) 1.02-1.23). Such association was still significant after adjustment (adjusted OR=1.16, 95%CI 1.02-1.31). details are presented in Table 3 .
The influence of acute LAR lesion on LAAC was revealed by TEE. In the 3rd month, Residual flow was observed in 6 patients, 4 with Watchman and 2 with LAmbre. All four cases with Watchman device had minimal residual flow (0.9-2.1 mm) at the inferior border at 135° (Figure 3 A-D ), while 2 cases of LAmbre device developed relatively larger (2.5 mm and 4.2 mm) residual flows at the LAR border at 90° (Figure 3 E & F ). Besides, through a mean follow-up time of 626.4±212.2 days, survival analysis showed that there was no difference between mild and severe LAR lesion groups on AA recurrence and rehospitalization. (Figure 4 ). And the clinical outcomes were similar between groups, as listed in Table 4 .