{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T07:57:47Z","timestamp":1773647867924,"version":"3.50.1"},"reference-count":32,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T00:00:00Z","timestamp":1763424000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T00:00:00Z","timestamp":1763424000000},"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":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Obese patients with atrial fibrillation (AF) are at an increased risk of thromboembolic and bleeding events. While direct oral anticoagulants (DOACs) are the standard therapy for stroke prevention in AF, their use is associated with a significant bleeding risk in this population. Comparative data of left appendage atrial occlusion (LAAO) vs. DOACs in this group are currently lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare the 5\u2010year clinical outcomes of LAAO vs. DOACs in obese patients with AF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Data were extracted from the TriNetX database, identifying obese patients with AF (BMI \u226540\u00a0kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ). Two cohorts were defined: those undergoing LAAO (\n                      <jats:italic>n\u00a0<\/jats:italic>\n                      =\u00a01571) and those treated with DOACs (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0103,047). Propensity score matching was conducted to adjust for demographics, comorbidities, and stroke\/bleeding risk scores, resulting in matched cohorts of 1566 patients each. Outcomes assessed included ischemic stroke, non\u2010traumatic intracranial hemorrhage, major bleeding, MI, and all\u2010cause mortality. Kaplan\u2013Meier survival curves and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated for group comparisons.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      At 5 years, stroke rates were similar between LAAO and DOAC groups (HR:1.00; 95% CI: 0.69\u20131.43;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.984), as were major bleeding rates similar (HR:0.99; 95% CI: 0.71\u20131.42;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.969). MI risk was comparable between the groups (HR:1.05; 95% CI: 0.66\u20131.36;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.772). Importantly, LAAO was associated with lower all\u2010cause mortality (HR:0.64; 95% CI: 0.54\u20130.76;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In obese patients with AF, LAAO offers a comparable stroke and bleeding protection to DOACs, while reducing all\u2010cause mortality over 5 years. These findings underscore the potential of LAAO as a long\u2010term strategy for stroke prevention in this high\u2010risk population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pace.70089","type":"journal-article","created":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T13:19:57Z","timestamp":1763471997000},"page":"180-186","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Outcomes of LAAO vs. DOACs in Obese Patients With Atrial Fibrillation a 5\u2010Year Propensity\u2010Matched Analysis"],"prefix":"10.1111","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-6590-0344","authenticated-orcid":false,"given":"Mohamad","family":"Mdaihly","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine Cleveland Clinic Cardiac Electrophysiology and Pacing Section  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Issam","family":"Motairek","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Cleveland Clinic Cardiac Electrophysiology and Pacing Section  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arwa","family":"Younis","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Cleveland Clinic Cardiac Electrophysiology and Pacing Section  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chadi","family":"Tabaja","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Cleveland Clinic Cardiac Electrophysiology and Pacing Section  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8553-6996","authenticated-orcid":false,"given":"Joe","family":"Demian","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Cleveland Clinic Cardiac Electrophysiology and Pacing Section  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6239-3655","authenticated-orcid":false,"given":"Adele","family":"Watfa","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Cleveland Clinic Cardiac Electrophysiology and Pacing Section  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Besir","family":"Besir","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Cleveland Clinic Cardiac Electrophysiology and Pacing Section  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayman A.","family":"Hussein","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Cleveland Clinic Cardiac Electrophysiology and Pacing Section  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tyler","family":"Taigen","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Cleveland Clinic Cardiac Electrophysiology and Pacing Section  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mandeep","family":"Bhargava","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Cleveland Clinic Cardiac Electrophysiology and Pacing Section  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed","family":"Kanj","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Cleveland Clinic Cardiac Electrophysiology and Pacing Section  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bryan","family":"Baranowski","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Cleveland Clinic Cardiac Electrophysiology and Pacing Section  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wael","family":"Jaber","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Cleveland Clinic Cardiac Electrophysiology and Pacing Section  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pasquale","family":"Santangeli","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Cleveland Clinic Cardiac Electrophysiology and Pacing Section  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mina","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Cleveland Clinic Cardiac Electrophysiology and Pacing Section  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Walid I.","family":"Saliba","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Cleveland Clinic Cardiac Electrophysiology and Pacing Section  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oussama M.","family":"Wazni","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Cleveland Clinic Cardiac Electrophysiology and Pacing Section  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,11,18]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2013.05.063"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2023.08.017"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/str.0000000000000375"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140\u20106736(13)62343\u20100"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2019.10.047"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euw241"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw658"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140\u20106736(24)01548\u20104"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2019.10.035"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2023.12.001"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/0003\u20104975(95)00887\u2010x"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140\u20106736(09)61343\u2010x"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euz258"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.10.021"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.04.067"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2024.01.018"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2023.05.044"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2020.09.051"},{"key":"e_1_2_11_20_1","unstructured":"TriNetX \u201cTriNetX | Real\u2010world Data for the Life Sciences and Healthcare \u201d accessed December 2 2024 https:\/\/trinetx.com\/2023."},{"key":"e_1_2_11_21_1","unstructured":"TriNetX.TriNetX Research Data Dictionary.TriNetX LLC;2019 https:\/\/trinetx.com\/2019."},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.121.056355"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.31646"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/cpt.2369"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2020.06.010"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2015.0374"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.3171\/2019.4.Jns19252"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2018.07.040"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1161\/jaha.121.027001"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.10.023"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1161\/jaha.123.029421"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.shj.2022.100096"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.122.062765"}],"container-title":["Pacing and Clinical Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70089","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/pace.70089","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70089","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T07:12:06Z","timestamp":1773645126000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pace.70089"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,18]]},"references-count":32,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1111\/pace.70089"],"URL":"https:\/\/doi.org\/10.1111\/pace.70089","archive":["Portico"],"relation":{},"ISSN":["0147-8389","1540-8159"],"issn-type":[{"value":"0147-8389","type":"print"},{"value":"1540-8159","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,18]]},"assertion":[{"value":"2025-08-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-03","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-18","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}