{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T06:29:16Z","timestamp":1793773756318,"version":"4.6.1"},"reference-count":28,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","jacc.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["JACC: Clinical Electrophysiology"],"published-print":{"date-parts":[[2026,10]]},"DOI":"10.1016\/j.jacep.2026.09.018","type":"journal-article","created":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T01:56:10Z","timestamp":1792720570000},"update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pulsed Field Ablation of the Left Atrial Appendage Before Mechanical Closure to Reduce Peri-Device Leak (STUN-AF)"],"prefix":"10.1016","author":[{"given":"John R.","family":"Power","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8253-947X","authenticated-orcid":false,"given":"Devi G.","family":"Nair","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shephal K.","family":"Doshi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohit K.","family":"Turagam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6356-9809","authenticated-orcid":false,"given":"Mohamed","family":"Mraiyan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ganesh","family":"Nair","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4341-7151","authenticated-orcid":false,"given":"Brandon","family":"Doty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alette","family":"Laughton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7066-7108","authenticated-orcid":false,"given":"Maryam","family":"Saleem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sai","family":"Seemala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3464-3341","authenticated-orcid":false,"given":"Ariel","family":"Banai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Connor","family":"Oates","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengyue","family":"Jin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manasvi","family":"Gupta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Musikantow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0081-0356","authenticated-orcid":false,"given":"Joshua","family":"Lampert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1103-9931","authenticated-orcid":false,"given":"William","family":"Whang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srinivas","family":"Dukkipati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivek Y.","family":"Reddy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.jacep.2026.09.018_bib1","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1056\/NEJMoa2408308","article-title":"Left atrial appendage closure after ablation for atrial fibrillation","volume":"392","author":"Wazni","year":"2025","journal-title":"N Engl J Med"},{"key":"10.1016\/j.jacep.2026.09.018_bib2","doi-asserted-by":"crossref","first-page":"2083","DOI":"10.1056\/NEJMoa2517213","article-title":"Left atrial appendage closure or anticoagulation for atrial fibrillation","volume":"394","author":"Doshi","year":"2026","journal-title":"N Engl J Med"},{"key":"10.1016\/j.jacep.2026.09.018_bib3","doi-asserted-by":"crossref","first-page":"1348","DOI":"10.1016\/j.jcmg.2025.07.018","article-title":"Outcomes of left atrial appendage patency after device closure detected by cardiac CT: a meta-analysis","volume":"18","author":"Jacquemyn","year":"2025","journal-title":"JACC Cardiovasc Imaging"},{"key":"10.1016\/j.jacep.2026.09.018_bib4","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/j.jacc.2022.04.062","article-title":"Impact of peridevice leak on 5-year outcomes after left atrial appendage closure","volume":"80","author":"Dukkipati","year":"2022","journal-title":"J Am Coll Cardiol"},{"key":"10.1016\/j.jacep.2026.09.018_bib5","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1016\/j.jacep.2022.03.001","article-title":"Clinical impact of residual leaks following left atrial appendage occlusion: insights from the NCDR LAAO registry","volume":"8","author":"Alkhouli","year":"2022","journal-title":"JACC Clin Electrophysiol"},{"key":"10.1016\/j.jacep.2026.09.018_bib6","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.125.044422","article-title":"Impact of peridevice leak on clinical outcomes after left atrial appendage closure: the OCEAN-LAAC registry","volume":"14","author":"Saito","year":"2025","journal-title":"J Am Heart Assoc"},{"key":"10.1016\/j.jacep.2026.09.018_bib7","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCINTERVENTIONS.123.013750","article-title":"Outcomes with the WATCHMAN FLX in everyday clinical practice from the NCDR left atrial appendage occlusion registry","volume":"17","author":"Kapadia","year":"2024","journal-title":"Circ Cardiovasc Interv"},{"key":"10.1016\/j.jacep.2026.09.018_bib8","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCINTERVENTIONS.121.011727","article-title":"Improved left atrial appendage closure with the new-generation WATCHMAN FLX by cardiac computed tomography angiography at 45 days postimplant","volume":"15","author":"Ranard","year":"2022","journal-title":"Circ Cardiovasc Interv"},{"key":"10.1016\/j.jacep.2026.09.018_bib9","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1056\/NEJMoa2513310","article-title":"Left atrial appendage closure or medical therapy in atrial fibrillation","volume":"394","author":"Landmesser","year":"2026","journal-title":"N Engl J Med"},{"key":"10.1016\/j.jacep.2026.09.018_bib10","doi-asserted-by":"crossref","first-page":"2127","DOI":"10.1016\/j.jcin.2022.09.001","article-title":"Peridevice leak after transcatheter left atrial appendage occlusion: an analysis of the amulet IDE trial","volume":"15","author":"Price","year":"2022","journal-title":"JACC Cardiovasc Interv"},{"key":"10.1016\/j.jacep.2026.09.018_bib11","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1161\/CIRCULATIONAHA.109.928903","article-title":"Left atrial appendage: an underrecognized trigger site of atrial fibrillation","volume":"122","author":"Di Biase","year":"2010","journal-title":"Circulation"},{"key":"10.1016\/j.jacep.2026.09.018_bib12","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1016\/j.jacc.2023.01.017","article-title":"Nonthrombogenic roles of the left atrial appendage: JACC review topic of the week","volume":"81","author":"Alkhouli","year":"2023","journal-title":"J Am Coll Cardiol"},{"key":"10.1016\/j.jacep.2026.09.018_bib13","doi-asserted-by":"crossref","first-page":"1929","DOI":"10.1016\/j.jacc.2016.07.770","article-title":"Left atrial appendage isolation in patients with longstanding persistent AF undergoing catheter ablation: BELIEF trial","volume":"68","author":"Di Biase","year":"2016","journal-title":"J Am Coll Cardiol"},{"key":"10.1016\/j.jacep.2026.09.018_bib14","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.jacep.2025.08.027","article-title":"Prevalence of peridevice leak in patients with left atrial appendage-occlusion vs without electrically isolated left atrial appendage","volume":"12","author":"Mohanty","year":"2026","journal-title":"JACC Clin Electrophysiol"},{"key":"10.1016\/j.jacep.2026.09.018_bib15","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.125.046374","article-title":"Left atrial appendage electrical isolation reduces residual patency after device closure in patients with persistent atrial fibrillation","volume":"15","author":"Yao","year":"2026","journal-title":"J Am Heart Assoc"},{"key":"10.1016\/j.jacep.2026.09.018_bib16","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1093\/ehjci\/jeae236","article-title":"Reproducibility of cardiac computed tomography classifications of hypoattenuated thickening and peridevice leak following left atrial appendage closure","volume":"26","author":"Kramer","year":"2025","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"10.1016\/j.jacep.2026.09.018_bib17","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCIMAGING.125.018151","article-title":"Cardiac CT versus transesophageal echocardiography following left atrial appendage closure: a systematic review and meta-analysis","volume":"18","author":"Tan","year":"2025","journal-title":"Circ Cardiovasc Imaging"},{"key":"10.1016\/j.jacep.2026.09.018_bib18","article-title":"Pulsed-field ablation with transcatheter left atrial appendage occlusion for left atrial appendage-origin atrial tachycardia","volume":"31","author":"Komatsu","year":"2026","journal-title":"JACC Case Rep"},{"key":"10.1016\/j.jacep.2026.09.018_bib19","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1161\/CIRCULATIONAHA.125.074485","article-title":"Pulsed field ablation of persistent atrial fibrillation with continuous electrocardiographic monitoring follow-up: ADVANTAGE AF phase 2","volume":"152","author":"Reddy","year":"2025","journal-title":"Circulation"},{"key":"10.1016\/j.jacep.2026.09.018_bib20","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1016\/j.jacep.2023.12.015","article-title":"Nitroglycerin to ameliorate coronary artery spasm during focal pulsed-field ablation for atrial fibrillation","volume":"10","author":"Malyshev","year":"2024","journal-title":"JACC Clin Electrophysiol"},{"key":"10.1016\/j.jacep.2026.09.018_bib21","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCEP.125.014026","article-title":"Feasibility and safety of pulsed field ablation for coronary sinus and left atrial appendage isolation and mitral isthmus ablation: acute and chronic findings","volume":"18","author":"La Fazia","year":"2025","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"10.1016\/j.jacep.2026.09.018_bib22","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1016\/j.hrthm.2009.02.029","article-title":"Anatomic evaluation of the left phrenic nerve relevant to epicardial and endocardial catheter ablation: implications for phrenic nerve injury","volume":"6","author":"S\u00e1nchez-Quintana","year":"2009","journal-title":"Heart Rhythm"},{"key":"10.1016\/j.jacep.2026.09.018_bib23","doi-asserted-by":"crossref","first-page":"1808","DOI":"10.1161\/CIRCULATIONAHA.122.061497","article-title":"Coronary arterial spasm during pulsed field ablation to treat atrial fibrillation","volume":"146","author":"Reddy","year":"2022","journal-title":"Circulation"},{"key":"10.1016\/j.jacep.2026.09.018_bib24","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1001\/jamacardio.2023.4405","article-title":"Coronary artery spasm during pulsed field vs radiofrequency catheter ablation of the mitral isthmus","volume":"9","author":"Zhang","year":"2024","journal-title":"JAMA Cardiol"},{"key":"10.1016\/j.jacep.2026.09.018_bib25","article-title":"Simultaneous pulsed field ablation and mechanical closure of left atrial appendage using a novel device","volume":"22","author":"Tang","year":"2023","journal-title":"JACC Case Rep"},{"key":"10.1016\/j.jacep.2026.09.018_bib26","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1016\/j.jacbts.2024.05.008","article-title":"Percutaneous LAAO and pulsed-field isolation in a canine model: feasibility and safety evaluation","volume":"9","author":"Yu","year":"2024","journal-title":"JACC Basic Transl Sci"},{"key":"10.1016\/j.jacep.2026.09.018_bib27","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1016\/j.jacc.2011.11.028","volume":"59","author":"Viles-Gonzalez","year":"2012","journal-title":"J Am Coll Cardiol"},{"key":"10.1016\/j.jacep.2026.09.018_bib28","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1093\/eurheartj\/ehad828","article-title":"Residual leaks following percutaneous left atrial appendage occlusion and outcomes: a meta-analysis","volume":"45","author":"Samaras","year":"2024","journal-title":"Eur Heart J"}],"container-title":["JACC: Clinical Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2405500X26008765?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2405500X26008765?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T06:19:28Z","timestamp":1793773168000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S2405500X26008765"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":28,"alternative-id":["S2405500X26008765"],"URL":"https:\/\/doi.org\/10.1016\/j.jacep.2026.09.018","relation":{},"ISSN":["2405-500X"],"issn-type":[{"value":"2405-500X","type":"print"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Pulsed Field Ablation of the Left Atrial Appendage Before Mechanical Closure to Reduce Peri-Device Leak (STUN-AF)","name":"articletitle","label":"Article Title"},{"value":"JACC: Clinical Electrophysiology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jacep.2026.09.018","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 by the American College of Cardiology Foundation. Published by Elsevier.","name":"copyright","label":"Copyright"}]}}