{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,22]],"date-time":"2026-03-22T13:36:28Z","timestamp":1774186588170,"version":"3.50.1"},"reference-count":19,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,7,26]],"date-time":"2023-07-26T00:00:00Z","timestamp":1690329600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Among patients with non\u2010valvular atrial fibrillation (AF) and percutaneous left atrial appendage closure (LAAC) undergoing direct current cardioversion (DCCV), the need for and use of LAA imaging and oral anticoagulation (OAC) is unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>The purpose of this study is to evaluate the real\u2010world use of transesophageal echocardiography (TEE) or cardiac computed tomography angiography (CCTA) before DCCV and use of OAC pre\u2010 and post\u2010DCCV in patients with AF status post percutaneous LAAC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective single center study included all patients who underwent DCCV after percutaneous LAAC from 2016 to 2022. Key measures were completion of TEE or CCTA pre\u2010DCCV, OAC use pre\u2010 and post\u2010DCCV, incidence of left atrial thrombus (LAT) or device\u2010related thrombus (DRT), incidence of peri\u2010device leak (PDL), and DCCV\u2010related complications (stroke, systemic embolism, device embolization, major bleeding, or death) within 30 days.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 76 patients with AF and LAAC underwent 122 cases of DCCV. LAAC consisted of 47 (62%), 28 (37%), and 1 (1%) case of Watchman 2.5, Watchman FLX, and Lariat, respectively. Among the 122 DCCV cases, 31 (25%) cases were identified as \u201cnon\u2010guideline based\u201d due to: (1) no OAC for 3 weeks and no LAA imaging within 48\u2009h before DCCV in 12 (10%) cases, (2) no OAC for 4 weeks following DCCV in 16 (13%) cases, or (3) both in 3 (2%) cases. Among the 70 (57%) cases that underwent TEE or CCTA before DCCV, 16 (23%) cases had a PDL with a mean size of 3.0\u2009\u00b1\u20091.1\u2009mm, and 4 (6%) cases had a LAT\/DRT on TEE resulting in cancellation. There were no DCCV\u2010related complications within 30 days.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>There is a widely varied practice pattern of TEE, CCTA, and OAC use with DCCV after LAAC, with a 6% rate of LAT\/DRT. LAA imaging before DCCV appears prudent in all cases, especially within 1 year of LAAC, to assess for device position, PDL, and LAT\/DRT.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.15999","type":"journal-article","created":{"date-parts":[[2023,7,26]],"date-time":"2023-07-26T13:34:11Z","timestamp":1690378451000},"page":"1698-1705","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Direct current cardioversion practices following percutaneous left atrial appendage closure"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9541-7746","authenticated-orcid":false,"given":"Sapan","family":"Bhuta","sequence":"first","affiliation":[{"name":"Section of Electrophysiology, Division of Cardiovascular Medicine, Ross Heart Hospital The Ohio State University Wexner Medical Center Columbus Ohio 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S.","family":"Augostini","sequence":"additional","affiliation":[{"name":"Section of Electrophysiology, Division of Cardiovascular Medicine, Ross Heart Hospital The Ohio State University Wexner Medical Center Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven J.","family":"Kalbfleisch","sequence":"additional","affiliation":[{"name":"Section of Electrophysiology, Division of Cardiovascular Medicine, Ross Heart Hospital The Ohio State University Wexner Medical Center Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salvatore J.","family":"Savona","sequence":"additional","affiliation":[{"name":"Section of Electrophysiology, Division of Cardiovascular Medicine, Ross Heart Hospital The Ohio State University Wexner Medical Center Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toshimasa","family":"Okabe","sequence":"additional","affiliation":[{"name":"Section of Electrophysiology, Division of Cardiovascular Medicine, Ross Heart Hospital The Ohio State University Wexner Medical Center Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3821-3872","authenticated-orcid":false,"given":"Mahmoud","family":"Houmsse","sequence":"additional","affiliation":[{"name":"Section of Electrophysiology, Division of Cardiovascular Medicine, Ross Heart Hospital The Ohio State University Wexner Medical Center Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3343-7618","authenticated-orcid":false,"given":"Muhammad R.","family":"Afzal","sequence":"additional","affiliation":[{"name":"Section of Electrophysiology, Division of Cardiovascular Medicine, Ross Heart Hospital The Ohio State University Wexner Medical Center Columbus Ohio 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