{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T12:08:32Z","timestamp":1784030912556,"version":"3.55.0"},"reference-count":27,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T00:00:00Z","timestamp":1771977600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T00:00:00Z","timestamp":1771977600000},"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":[[2026,7]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n \n Current guidelines recommend oral anticoagulation in atrial fibrillation (AF) patients with a CHA\n 2<\/jats:sub>\n DS\n 2<\/jats:sub>\n \u2010VASc score \u22652 for stroke prevention. However, Centers for Medicare & Medicaid Services (CMS) reimburses left atrial appendage occlusion (LAAO) for patients with CHA\n 2<\/jats:sub>\n DS\n 2<\/jats:sub>\n \u2010VASc score \u22653. This study aimed to evaluate differences in outcomes and complications of LAAO therapy in AF patients with a CHA\n 2<\/jats:sub>\n DS\n 2<\/jats:sub>\n \u2010VASc score of \u2265 3 versus < 3.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n National Inpatient Sample (NIS) and International Classification of Diseases, Tenth Revision codes were used to identify LAAO device implantation in the U.S. from years 2016 to 2020. The study population was stratified by stroke risk into two groups, CHA\n 2<\/jats:sub>\n DS\n 2<\/jats:sub>\n \u2010VASc \u2265 3 and < 3. Study endpoints assessed included procedural complications, inpatient outcomes and resource utilization.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 73,795 and 15,500 LAAO devices were implanted in patients with CHA\n 2<\/jats:sub>\n DS\n 2<\/jats:sub>\n \u2010VASc \u2265 3 and < 3, respectively. Compared to patients with CHA\n 2<\/jats:sub>\n DS\n 2<\/jats:sub>\n \u2010VASc score of \u2265 3, patients with CHA\n 2<\/jats:sub>\n DS\n 2<\/jats:sub>\n \u2010VASc < 3 had lower overall (6.9%\u00a0vs 9.9%,\n P<\/jats:italic>\n < 0.01) and major (4.5%\u00a0vs 6.2%,\n P<\/jats:italic>\n < 0.01) complications in the crude analysis. After multivariable adjustment for potential confounders, CHA\n 2<\/jats:sub>\n DS\n 2<\/jats:sub>\n \u2010VASc < 3 was associated with lower overall complications (aOR 0.84, 95% CI 0.78 \u2013 0.91), major complications (aOR 0.90, 95% CI 0.81\u20130.99) and cost of hospitalization (aOR 0.95, 95% CI 0.91\u20130.99).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Patients with CHA\n 2<\/jats:sub>\n DS\n 2<\/jats:sub>\n \u2010VASc < 3 had lower complications and hospitalization costs after LAAO device implantation. These data, if redemonstrated in a large randomized trial, can have important clinical implications for stroke prevention in AF patients.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/pace.70184","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T18:24:48Z","timestamp":1772994288000},"page":"842-850","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative Outcomes of Left Atrial Appendage Occlusion Device Implantation in Atrial Fibrillation Patients With Lower Stroke Risk"],"prefix":"10.1111","volume":"49","author":[{"given":"Amanda","family":"Nguyen","sequence":"first","affiliation":[{"name":"Department of Medicine University of California Davis Medical Center Sacramento California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Zia","family":"Khan","sequence":"additional","affiliation":[{"name":"Division of Cardiology Deborah Heart and Lung Center Browns Mills New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waleed","family":"Alruwaili","sequence":"additional","affiliation":[{"name":"Division of Cardiology West Virginia University Heart and Vascular Institute Morgantown West Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4452-6317","authenticated-orcid":false,"given":"Muhammad Usman","family":"Khan","sequence":"additional","affiliation":[{"name":"Division of Cardiology University of Florida Jacksonville Jacksonville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9804-898X","authenticated-orcid":false,"given":"Muhammad","family":"Bilal","sequence":"additional","affiliation":[{"name":"Department of Medicine Merit Health Wesley Hattiesburg Mississippi USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salman","family":"Zahid","sequence":"additional","affiliation":[{"name":"Division of Cardiology Oregon Health and Science University Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karthik","family":"Gonuguntla","sequence":"additional","affiliation":[{"name":"Division of Cardiology West Virginia University Heart and Vascular Institute Morgantown West Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samrina","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Medicine Khyber Medical University Peshawar Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melody","family":"Mendez","sequence":"additional","affiliation":[{"name":"Department of Medicine University of California Davis Medical Center Sacramento California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zain Ul Abideen","family":"Asad","sequence":"additional","affiliation":[{"name":"Division of Cardiology University of Oklahoma Oklahoma City Oklahoma USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siddharth","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Division of Cardiology University of Oklahoma Oklahoma City Oklahoma USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sudarshan","family":"Balla","sequence":"additional","affiliation":[{"name":"Division of Cardiology West Virginia University Heart and Vascular Institute Morgantown West Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Darden","sequence":"additional","affiliation":[{"name":"Division of Cardiology Kansas City Heart Rhythm Institute Overland Park Kansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Bilal","family":"Munir","sequence":"additional","affiliation":[{"name":"Section of Electrophysiology Division of Cardiology University of California Davis Sacramento California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,25]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.4244\/EIJ\u2010D\u201022\u201000627"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.123.029421"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000016560"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.016715"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001193"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa612"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.121.022274"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.10.021"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.15192"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.04.029"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.04.067"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.10.023"},{"key":"e_1_2_11_14_1","unstructured":"Percutaneous Left Atrial Appendage (LAA) Closure Therapy. Centers for Medicare & Medicaid Services https:\/\/www.cms.gov\/medicare\u2010coverage\u2010database\/view\/ncacal\u2010decision\u2010memo.aspx?proposed=N&NCAId=281."},{"key":"e_1_2_11_15_1","volume-title":"Boston Scientific Receives FDA Approval for WATCHMANTMLeft Atrial Appendage Closure Device","year":"2024"},{"key":"e_1_2_11_16_1","volume-title":"Overview of the National (Nationwide) Inpatient Sample (NIS)","year":"2023"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.121.027001"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2022.06.065"},{"key":"e_1_2_11_19_1","unstructured":"CMS Releases Latest Enrollment Figures for Medicare Medicaid and Children's Health Insurance Program (CHIP).;2021 https:\/\/www.cms.gov\/newsroom\/news\u2010alert\/cms\u2010releases\u2010latest\u2010enrollment\u2010figures\u2010medicare\u2010medicaid\u2010and\u2010childrens\u2010health\u2010insurance\u2010program\u2010chip."},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2020.09.051"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00392\u2010021\u201001983\u2010z"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.121.008418"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2022.949732"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.14594"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/CRD.0000000000000246"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euv069"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.119.041303"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1080\/24748706.2020.1834173"}],"container-title":["Pacing and Clinical Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70184","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/pace.70184","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70184","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T11:47:58Z","timestamp":1784029678000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pace.70184"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,25]]},"references-count":27,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1111\/pace.70184"],"URL":"https:\/\/doi.org\/10.1111\/pace.70184","archive":["Portico"],"relation":{},"ISSN":["0147-8389","1540-8159"],"issn-type":[{"value":"0147-8389","type":"print"},{"value":"1540-8159","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,25]]},"assertion":[{"value":"2024-06-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}