{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T03:50:15Z","timestamp":1791949815488,"version":"4.3.4"},"reference-count":17,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"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":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Oral anticoagulants (OACs), preferably direct (D)\/non\u2010vitamin K (N) dependent OACs [DOACs\/NOACs] are recommended for the management of patients with non\u2010valvular atrial fibrillation (AF) at risk for thromboembolic events, including stroke. Left atrial appendage occlusion (LAAO) device implantation has been considered for patients who are unsuitable for OACs or prefer not to take them. Herein, we discuss the clinical evidence for routine use of LAAO instead of OACs for patients with AF at risk of thromboembolic events, stroke, and bleeding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>From pertinent, recent, randomized clinical trials, the CHAMPION\u2010AF (Watchman Flx vs. NOAC for Embolic Protection in the Management of Patients with Non\u2010Valvular Atrial Fibrillation), and CLOSURE\u2010AF (Catheter\u2010Based Left Atrial Appendage Closure in Patients with Atrial Fibrillation at High Risk of Stroke and Bleeding as Compared with Best Medical Therapy) were selected for review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>As interpreted by the authors of the CHAMPION\u2010AF trial, LAAOs were considered non\u2010inferior to NOACs at 3 years. In the CLOSURE\u2010AF trial, non\u2010inferiority criteria were not met. For safety, that is, bleeding, LAAO was considered superior in CHAMPION\u2010AF. We found several points related to both trials that are critical to interpret the results and clinical implications of these trials. These points are particularly related to the interpretation of non\u2010inferiority trial design, selection bias, combined primary endpoint, bleeding and peri\u2010procedural bleeding complications, serious adverse events, cross\u2010over rates, sub\u2010group analyses, conflicts of interest, and mechanism of stroke.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Data from the CHAMPION\u2010AF and CLOSURE trials do not favor routine and widespread use of LAAO devices in non\u2010valvular AF patients over use of OACs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jce.70494","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T18:27:52Z","timestamp":1788892072000},"page":"2403-2408","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Should Left Atrial Appendage Occlusion Devices Be Routinely Used Instead of Oral Anticoagulants to Prevent Thromboembolic Events, Stroke, and Bleeding for Patients With Non\u2010Valvular Atrial Fibrillation?"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4207-0387","authenticated-orcid":false,"given":"Bharat K.","family":"Kantharia","sequence":"first","affiliation":[{"name":"Cardiovascular and Heart Rhythm Consultants Icahn School of Medicine at Mount Sinai New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2469-3916","authenticated-orcid":false,"given":"April","family":"Slee","sequence":"additional","affiliation":[{"name":"New Arch Consulting LLC Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6044-045X","authenticated-orcid":false,"given":"Brian","family":"Olshansky","sequence":"additional","affiliation":[{"name":"Fran\u00e7ois M. Abboud Cardiovascular Research Center University of Iowa Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"crossref","unstructured":"J. A.Joglar M. K.Chung A. L.Armbruster et al. \u201c2023 ACC\/AHA\/ACCP\/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines \u201dCirculation149 no. 1 (January 2024): e1\u2013e156 Erratum in:Circulation149 no. 1 (January 2024): e167. Erratum in:Circulation149 no. 9 (February 2024): e936. Erratum in:Circulation149 no. 24 (June 2024): e1413 https:\/\/doi.org\/10.1161\/CIR.0000000000001193.","DOI":"10.1161\/CIR.0000000000001193"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae176"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10840-022-01195-z"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2517213"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2513310"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2408308"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.124.068928"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2019-315772"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacadv.2024.101021"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.12.040"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.7326\/M21-4653"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.7326\/M22-2271"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euae204"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.14997"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.15420\/aer.2025.53"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2509688"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2026.107367"}],"container-title":["Journal of Cardiovascular Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jce.70494","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jce.70494","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jce.70494","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T03:42:25Z","timestamp":1791949345000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jce.70494"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,8]]},"references-count":17,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/jce.70494"],"URL":"https:\/\/doi.org\/10.1111\/jce.70494","archive":["Portico"],"relation":{},"ISSN":["1045-3873","1540-8167"],"issn-type":[{"value":"1045-3873","type":"print"},{"value":"1540-8167","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,8]]},"assertion":[{"value":"2026-05-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-26","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}