{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T13:01:21Z","timestamp":1787317281854,"version":"build-2736575974"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2023,7,13]],"date-time":"2023-07-13T00:00:00Z","timestamp":1689206400000},"content-version":"vor","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Patients with atrial fibrillation who despite taking oral anti-coagulant therapy (OAT) suffer a stroke or systemic embolism (SSE) without vascular cause or who develop left atrial appendage (LAA) thrombus (LAAT) should be considered as having malignant LAA. The optimal treatment strategy to reduce SSE risk in such patients is unknown. The aim of the study is to investigate the diagnostic and therapeutic pathways for malignant LAA practiced in European cardiac centres.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>An 18-item online questionnaire on malignant LAA was disseminated by the European Heart Rhythm Association (EHRA) Scientific Initiatives Committee. A total of 196 physicians participated in the survey. There seems to be high confidence in transoesophageal echocardiography (TEE) imaging, considering LAAT diagnosis. Switching to another direct oral anti-coagulant (DOAC) is the preferred initial step for the treatment of malignant LAA followed by a switch to vitamin K antagonist (VKA), low-molecular-weight heparin, or continued\/optimized DOAC dosage, whereas LAA closure is the last option. Left atrial appendage closure is a viable option in patients with embolic stroke despite OAT and no evidence of thrombus at TEE (empty LAA) after comprehensive diagnostic measures to exclude other sources of embolism.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This EHRA survey provides a snapshot of the contemporary management of patients diagnosed with malignant LAA. Currently, the majority of patients are treated on an outpatient basis with either shifting from VKA to DOAC or from one DOAC to another. Left atrial appendage closure in this population seems to be reserved for patients with higher bleeding risk or complications of malignant LAA, such as stroke.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/europace\/euad204","type":"journal-article","created":{"date-parts":[[2023,7,12]],"date-time":"2023-07-12T08:52:59Z","timestamp":1689151979000},"source":"Crossref","is-referenced-by-count":15,"title":["Diagnostic and therapeutic pathways for the malignant left atrial appendage: European Heart Rhythm Association physician survey"],"prefix":"10.1093","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6864-3999","authenticated-orcid":false,"given":"Ante","family":"Anic","sequence":"first","affiliation":[{"name":"Department for Cardiovascular Diseases, University Hospital Centre Split , Soltanska 1, 21000 Split , Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6751-5242","authenticated-orcid":false,"given":"Darija","family":"Bakovic","sequence":"additional","affiliation":[{"name":"Department for Cardiovascular Diseases, University Hospital Centre Split , Soltanska 1, 21000 Split , Croatia"},{"name":"School of Medicine, University of Split , Split , Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7583-9036","authenticated-orcid":false,"given":"Zrinka","family":"Jurisic","sequence":"additional","affiliation":[{"name":"Department for Cardiovascular Diseases, University Hospital Centre Split , Soltanska 1, 21000 Split , Croatia"},{"name":"School of Medicine, University of Split , Split , Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1673-7712","authenticated-orcid":false,"given":"Michal","family":"Farkowski","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration , Warsaw , Poland"},{"name":"II Department of Heart Arrhythmia, National Institute of Cardiology , Warsaw , Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1904-0259","authenticated-orcid":false,"given":"Lucija","family":"Lisica","sequence":"additional","affiliation":[{"name":"Department for Cardiovascular Diseases, University Hospital Centre Split , Soltanska 1, 21000 Split , Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7266-2087","authenticated-orcid":false,"given":"Toni","family":"Breskovic","sequence":"additional","affiliation":[{"name":"Department for Cardiovascular Diseases, University Hospital Centre Split , Soltanska 1, 21000 Split , Croatia"},{"name":"School of Medicine, University of Split , Split , Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6473-2900","authenticated-orcid":false,"given":"Jens Erik","family":"Nielsen-Kudsk","sequence":"additional","affiliation":[{"name":"Aarhus University Hospital , Aarhus , Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4322-1183","authenticated-orcid":false,"given":"Laura","family":"Perrotta","sequence":"additional","affiliation":[{"name":"University Hospital Careggi, EP Lab , Florence , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9351-0760","authenticated-orcid":false,"given":"Carlo","family":"de Asmundis","sequence":"additional","affiliation":[{"name":"Heart Rhythm Management Centre, University Hospital (UZ) Brussels , Brussels , Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1280-7042","authenticated-orcid":false,"given":"Serge","family":"Boveda","sequence":"additional","affiliation":[{"name":"Cardiology-Heart Rhythm Management Department, Clinique Pasteur , Toulouse , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2355-6015","authenticated-orcid":false,"given":"Julian","family":"Chun","sequence":"additional","affiliation":[{"name":"CCB, Cardiology, Med. 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