Performing afib ablation combined with the placement of the Watchman device for LAA occlusion has been evaluated before, with results showing evidence of safety and ability to perform (6). This can save time and materials allowing patients to have two procedures simultaneously, preventing repeating exposure to possible risks that come with general anesthesia and transseptal puncture, and decreasing the total length of hospital stay (7-8). In this case, especially we proceeded with the combined procedure due to difficulty in obtaining access associated with total interruption of IVC and the obligation to use alternative non-conventional ways as the transhepatic access that may lead to higher risk upon repeating.