{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T18:52:01Z","timestamp":1792003921305,"version":"4.4.0"},"reference-count":24,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Contrast injection is standard in left atrial appendage occlusion (LAAO) procedures but may be forgone given advances in imaging and device technology. The contrast\u2010free approach remains underexplored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To compare the safety and efficacy of zero\u2010contrast versus contrast\u2010guided LAAO.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>All consecutive patients who underwent LAAO at our center between September 2018 and October 2022 using Watchman FLX\u2122 devices were enrolled in a prospectively maintained registry. A total of 621 patients were divided between zero\u2010contrast (326) and contrast\u2010guided (295) LAAO. Baseline, procedural, and follow\u2010up outcomes were compared. Periprocedural adverse events included major complications within 7 days. LAA closure success was defined as peri\u2010device leak \u2264\u20095\u2009mm on follow\u2010up imaging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Procedural success was 100% in zero\u2010contrast and 99.3% in contrast\u2010guided cases (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.2). Periprocedural adverse events occurred in six (1.8%) zero\u2010contrast and two (0.7%) contrast\u2010guided patients (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.3). At 45 days, 297 zero\u2010contrast versus 271 contrast\u2010guided patients had evaluable follow\u2010up imaging. LAA closure success was 99.3% (295) and 99.6% (270), respectively (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.99), while device\u2010related thrombus (DRT) was observed in three patients in each group (1.0% vs. 1.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.99). At 1 year, 68 zero\u2010contrast and 79 contrast\u2010guided patients had TEEs. LAA closure success remained high at 100% in both groups and DRT was observed in three patients from each (4.4% vs. 3.8%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.99). Ischemic stroke or systemic embolism occurred in 1.9% of zero\u2010contrast patients versus 2.1% in the contrast group within 1 year (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.8).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Zero\u2010contrast LAAO is a safe, effective, and efficient alternative to contrast\u2010guided implantation, with comparable procedural and clinical outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jce.70362","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T13:19:50Z","timestamp":1780924790000},"page":"1675-1684","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Zero\u2010Contrast Versus Contrast\u2010Guided Left Atrial Appendage Occlusion: A Comparative Analysis of Procedural and Long\u2010Term Outcomes"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-8553-6996","authenticated-orcid":false,"given":"Joe","family":"Demian","sequence":"first","affiliation":[{"name":"Cardiac Electrophysiology Section, Department of Cardiovascular Medicine Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"LaCombe","sequence":"additional","affiliation":[{"name":"Cardiac Electrophysiology Section, Department of Cardiovascular Medicine Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arwa","family":"Younis","sequence":"additional","affiliation":[{"name":"Cardiac Electrophysiology Section, Department of Cardiovascular Medicine Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Kanj","sequence":"additional","affiliation":[{"name":"Cardiac Electrophysiology Section, Department of Cardiovascular Medicine Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walid I.","family":"Saliba","sequence":"additional","affiliation":[{"name":"Cardiac Electrophysiology Section, Department of Cardiovascular Medicine Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pasquale","family":"Santangeli","sequence":"additional","affiliation":[{"name":"Cardiac Electrophysiology Section, Department of Cardiovascular Medicine Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chadi","family":"Tabaja","sequence":"additional","affiliation":[{"name":"Cardiac Electrophysiology Section, Department of Cardiovascular Medicine Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioan","family":"Liuba","sequence":"additional","affiliation":[{"name":"Cardiac Electrophysiology Section, Department of Cardiovascular Medicine Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan","family":"Baranowski","sequence":"additional","affiliation":[{"name":"Cardiac Electrophysiology Section, Department of Cardiovascular Medicine Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler L.","family":"Taigen","sequence":"additional","affiliation":[{"name":"Cardiac Electrophysiology Section, Department of Cardiovascular Medicine Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandeep","family":"Bhargava","sequence":"additional","affiliation":[{"name":"Cardiac Electrophysiology Section, Department of Cardiovascular Medicine Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oussama M.","family":"Wazni","sequence":"additional","affiliation":[{"name":"Cardiac Electrophysiology Section, Department of Cardiovascular Medicine Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayman A.","family":"Hussein","sequence":"additional","affiliation":[{"name":"Cardiac Electrophysiology Section, Department of Cardiovascular Medicine Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2023.01.011"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euz258"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-146-12-200706190-00007"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa612"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.108.516344"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.160.1.41"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euv309"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.114389"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)61343-X"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.050117"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-025-11675-1"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.8375"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2023.04.027"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2024.131939"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00392-018-1401-5"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2022.12.029"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.122.026295"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2018.03.022"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.10.010"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.123.013750"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.4244\/EIJY15M01_06"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.26903"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2016.11.029"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2024.05.016"}],"container-title":["Journal 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