{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T20:18:27Z","timestamp":1791317907213,"version":"4.3.1"},"reference-count":16,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,4,25]],"date-time":"2023-04-25T00:00:00Z","timestamp":1682380800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Incidental left atrial appendage (LAA) isolation may occur during radiofrequency ablation of persistent atrial fibrillation (AF). The study aims to describe the mechanisms and long\u2010term thromboembolic risk related to incidental LAA isolation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients who experienced incidental LAA isolation after AF ablation were included. Culprit sites where ablation resulted in LAA isolation were identified. Thromboembolic risk despite oral anticoagulation (OAC) was compared to that in a propensity\u2010matched control group without LAA isolation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Forty\u2010one patients with LAA isolation, and 82 matched patients without LAA isolation were included. The patient age, ejection fraction, LA diameter, and CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>\u2010VASc score were 64\u2009\u00b1\u200911 years, 55\u2009\u00b1\u200912%, 45.0\u2009\u00b1\u20097\u2009mm and 2.62\u2009\u00b1\u20091.5, respectively. Culprit sites included the LAA base, mitral isthmus, inferior LA, Bachmann\u2032s bundle, coronary sinus, and Marshall vein. After 4.2\u2009\u00b1\u20093.6 years follow\u2010up, thromboembolism occurred in 7 of 41 patients (17%) with LAA isolation versus 3 of 82 patients (4%) without isolation (log rank <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.009, HR 5.14, 95% CI [1.32\u201319.94], <jats:italic>p<\/jats:italic>\u2009=\u2009.02). Patients with and without thromboembolism had similar CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>\u2010VASc scores (2.65\u2009\u00b1\u20091.3 vs. 2.71\u2009\u00b1\u20090.76, <jats:italic>p<\/jats:italic>\u2009=\u2009.89). Thromboembolism occurred during noncompliance with or temporary discontinuation of OAC in four of the seven\u00a0patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Incidental LAA isolation may occur during ablation of atrial arrhythmias in the vicinity of, or even at sites remote from the appendage. Patients with incidental LAA isolation had higher rates of thromboembolism compared to patients without isolation. Since thromboembolism may occur despite prescription for OAC, the risks of LAA isolation must be weighed against clinical benefit and appendage occlusion devices should be considered in vulnerable patients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.15889","type":"journal-article","created":{"date-parts":[[2023,3,19]],"date-time":"2023-03-19T15:10:26Z","timestamp":1679238626000},"page":"1152-1161","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Incidental left atrial appendage isolation after catheter ablation of persistent atrial fibrillation: Mechanisms and long\u2010term risk of thromboembolism"],"prefix":"10.1111","volume":"34","author":[{"given":"Michael","family":"Ghannam","sequence":"first","affiliation":[{"name":"Department of Electrophysiology, Division of Cardiology University of Michigan Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krit","family":"Jongnarangsin","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology, Division of Cardiology University of Michigan Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamed","family":"Emami","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology, Division of Cardiology University of Michigan Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1879-4131","authenticated-orcid":false,"given":"Miki","family":"Yokokawa","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology, Division of Cardiology University of Michigan Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8608-8899","authenticated-orcid":false,"given":"Jackson J.","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology, Division of Cardiology University of Michigan Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Saeed","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology, Division of Cardiology University of Michigan Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hakan","family":"Oral","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology, Division of Cardiology University of Michigan Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fred","family":"Morady","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology, Division of Cardiology University of Michigan Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1270-6337","authenticated-orcid":false,"given":"Aman","family":"Chugh","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology, Division of Cardiology University of Michigan Ann Arbor Michigan 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