{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T12:04:21Z","timestamp":1784117061604,"version":"3.55.0"},"reference-count":28,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"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"],"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n The optimal strategy remains undefined in non\u2010valvular atrial fibrillation (NVAF) patients at very\u2010high stroke risk who show no documented AF recurrence on routine follow\u2010up after catheter ablation (CA) but cannot continue long\u2010term anticoagulation.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To describe the feasibility, procedural safety, and clinical outcomes of a combined approach involving left atrial appendage closure (LAAC) with pulmonary vein (PV) remapping and re\u2010isolation when reconnection was present in this selected real\u2010world population.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n In this prospective study, we enrolled NVAF patients with prior stroke who had no documented AF recurrence on routine surveillance after CA, but declined or were intolerant to long\u2010term anticoagulation. All participants underwent LAAC with concurrent electrophysiological remapping\/re\u2010isolation of reconnected PVs. Primary endpoints included thromboembolic (TE) events, bleeding, all\u2010cause mortality, and AF recurrences. Secondary endpoints covered periprocedural complications, peridevice leak (PDL), and device\u2010related thrombus (DRT), evaluated via short\u2010term imaging follow\u2010up.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n 43 patients (median CHA2DS2\u2010VASc score of 5.0 [IQR 4.0\u20136.0]) were included. The mean interval from CA to LAAC was 242.3 \u00b1 175.7 days. Procedural success was 95.3%. Implanted devices included Watchman 2.5 (75.6%), Watchman FLX (9.8%), Watchman FLX Pro (2.4%) and LACBES (12.2%). One periprocedural tamponade occurred (2.4%). Over a median follow\u2010up of 775 days, thromboembolic events occurred in 4.9% and bleeding in 9.8%. Device\u2010related thrombus and peridevice leak were observed in 5.3% and 7.9%. PV reconnection was detected in 31.7% of patients, all successfully re\u2010ablated, leading to 92.7% freedom from AF recurrence.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n In this selected single\u2010center cohort, combined LAAC with PV remapping and re\u2010isolation when indicated was feasible and associated with acceptable procedural outcomes. However, because of the single\u2010arm design, small sample size, and intermittent rhythm surveillance, the incremental clinical benefit of this combined strategy requires confirmation in larger controlled studies. Keywords: Secondary Stroke Prevention; Atrial Fibrillation Recurrence; Radiofrequency Catheter Ablation; Left Atrial Appendage Closure; Pulmonary Vein Re\u2010isolation<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/pace.70363","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T11:05:02Z","timestamp":1784113502000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Combined Left Atrial Appendage Closure and Pulmonary Vein Re\u2010Isolation in Very\u2010High Stroke\u2010Risk Patients"],"prefix":"10.1111","author":[{"given":"Qibin","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Cardiology The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang Wenzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenli","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Cardiology The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang Wenzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shengjie","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Cardiology The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang Wenzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lianguo","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiology The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang Wenzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingxing","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Cardiology The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang Wenzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lan","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Cardiology The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang Wenzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weijian","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Cardiology The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang Wenzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fangyi","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Cardiology The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang Wenzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"2620","DOI":"10.1161\/STROKEAHA.121.038239","article-title":"Recurrent Ischemic Stroke and Bleeding in Patients with Atrial Fibrillation Who Suffered an Acute Stroke While on Treatment with Nonvitamin K Antagonist Oral Anticoagulants: the RENO\u2010EXTEND Study","volume":"53","author":"Paciaroni M.","year":"2022","journal-title":"Stroke; A Journal of Cerebral Circulation"},{"key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1001\/jamaneurol.2025.1337","article-title":"Residual Risk of Recurrent Stroke Despite Anticoagulation in Patients with Atrial Fibrillation","volume":"82","author":"McCabe J. J.","year":"2025","journal-title":"JAMA Neurology"},{"key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"3314","DOI":"10.1093\/eurheartj\/ehae176","article-title":"2024 ESC Guidelines for the Management of Atrial Fibrillation Developed in Collaboration with the European Association for Cardio\u2010Thoracic Surgery (EACTS)","volume":"45","author":"Van Gelder I. C.","year":"2024","journal-title":"European Heart Journal"},{"key":"e_1_2_11_5_1","first-page":"198","article-title":"Antithrombotic Treatment for Secondary Prevention of Stroke and Other Thromboembolic Events in Patients with Stroke or Transient Ischemic Attack and Non\u2010Valvular Atrial Fibrillation: A European Stroke Organisation Guideline","volume":"4","author":"Klijn C. J.","year":"2019","journal-title":"European Heart Journal"},{"key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1111\/jce.15370","article-title":"Outcome and Safety of Intracardiac Echocardiography Guided Left Atrial Appendage Closure Within Zero\u2010Fluoroscopy Atrial Fibrillation Ablation Procedures","volume":"33","author":"Chen Y.\u2010H.","year":"2022","journal-title":"Journal of Cardiovascular Electrophysiology"},{"key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1253\/circj.CJ-17-0412","article-title":"Percutaneous Left Atrial Appendage Closure with LACBES\u226aSup\u226b\u00ae\u226a\/Sup\u226b Occluder\u3000\u2015 A Preclinical Feasibility Study \u2015","volume":"82","author":"Tang X.","year":"2017","journal-title":"Circulation Journal"},{"key":"e_1_2_11_8_1","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.ijcard.2022.08.007","article-title":"Long\u2010Term Outcome of Combined Catheter Ablation and Left Atrial Appendage Closure in Atrial Fibrillation Patients","volume":"368","author":"Chen M.","year":"2022","journal-title":"International Journal of Cardiology"},{"key":"e_1_2_11_9_1","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1001\/jamaneurol.2024.1892","article-title":"Recurrent Ischemic Stroke in Patients with Atrial Fibrillation While Receiving Oral Anticoagulants","volume":"81","author":"Hindsholm M. F.","year":"2024","journal-title":"JAMA Neurology"},{"key":"e_1_2_11_10_1","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1001\/jamacardio.2021.1232","article-title":"Evaluation of the Risk of Stroke without Anticoagulation Therapy in Men and Women with Atrial Fibrillation Aged 66 to 74 Years without Other CHA2 DS2 \u2010VASc Factors","volume":"6","author":"Abdel\u2010Qadir H.","year":"2021","journal-title":"JAMA Cardiology"},{"key":"e_1_2_11_11_1","doi-asserted-by":"crossref","first-page":"2166","DOI":"10.1161\/CIRCULATIONAHA.112.142158","article-title":"Efficacy and Safety of Apixaban Compared with Warfarin at Different Levels of Predicted International Normalized Ratio Control for Stroke Prevention in Atrial Fibrillation","volume":"127","author":"Wallentin L.","year":"2013","journal-title":"Circulation"},{"key":"e_1_2_11_12_1","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1093\/europace\/eur126","article-title":"Bleeding Risk Assessment and Management in Atrial Fibrillation Patients: a Position Document from the European Heart Rhythm Association, Endorsed by the European Society of Cardiology Working Group on Thrombosis","volume":"13","author":"Lip G. Y. H.","year":"2011","journal-title":"Europace"},{"key":"e_1_2_11_13_1","article-title":"Outcomes and Anticoagulation Use after Catheter Ablation for Atrial Fibrillation","volume":"12","author":"Freeman J. V.","year":"2019","journal-title":"Circulation: Arrhythmia and Electrophysiology"},{"key":"e_1_2_11_14_1","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1080\/03007995.2021.1897555","article-title":"Real\u2010World Persistence to Direct Oral Anticoagulants in Patients with Atrial Fibrillation: a Systematic Review and Network Meta\u2010Analysis","volume":"37","author":"Deitelzweig S.","year":"2021","journal-title":"Current Medical Research and Opinion"},{"key":"e_1_2_11_15_1","doi-asserted-by":"crossref","first-page":"3122","DOI":"10.1016\/j.jacc.2020.04.067","article-title":"Left Atrial Appendage Closure versus Direct Oral Anticoagulants in High\u2010Risk Patients with Atrial Fibrillation","volume":"75","author":"Osmancik P.","year":"2020","journal-title":"Journal of the American College of Cardiology"},{"key":"e_1_2_11_16_1","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.ahj.2017.12.007","article-title":"The Optimal Anti\u2010Coagulation for Enhanced\u2010Risk Patients Post\u2013Catheter Ablation for Atrial Fibrillation (OCEAN) Trial","volume":"197","author":"Verma A.","year":"2018","journal-title":"American Heart Journal"},{"key":"e_1_2_11_17_1","doi-asserted-by":"crossref","first-page":"1246","DOI":"10.1001\/jama.2025.14679","article-title":"Long\u2010Term Anticoagulation Discontinuation after Catheter Ablation for Atrial Fibrillation","volume":"334","author":"Kim D.","year":"2025","journal-title":"Jama"},{"key":"e_1_2_11_18_1","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1056\/NEJMoa2509688","article-title":"Antithrombotic Therapy after Successful Catheter Ablation for Atrial Fibrillation","volume":"394","author":"Verma A.","year":"2026","journal-title":"New England Journal of Medicine"},{"key":"e_1_2_11_19_1","doi-asserted-by":"crossref","first-page":"3470","DOI":"10.1093\/eurheartj\/ehw048","article-title":"Outcomes and Costs of Left Atrial Appendage Closure from Randomized Controlled Trial and Real\u2010World Experience Relative to Oral Anticoagulation","volume":"37","author":"Panikker S.","year":"2016","journal-title":"European Heart Journal"},{"key":"e_1_2_11_20_1","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1056\/NEJMoa2408308","article-title":"Left Atrial Appendage Closure After Ablation for Atrial Fibrillation","volume":"392","author":"Wazni O. M.","year":"2025","journal-title":"New England Journal of Medicine"},{"key":"e_1_2_11_21_1","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1016\/j.hrthm.2024.01.028","article-title":"Left Atrial Appendage Closure in Patients with Left Atrial Appendage Thrombus Guided by Intracardiac Echocardiography","volume":"21","author":"Wang B.","year":"2024","journal-title":"Heart Rhythm"},{"key":"e_1_2_11_22_1","first-page":"18","article-title":"Percutaneous Left Atrial Appendage Closure with the Watchman Device: a Systematic Review","volume":"20","author":"Maksym J.","year":"2024","journal-title":"Postepy Kardiol Interwencyjnej"},{"key":"e_1_2_11_23_1","first-page":"2914","article-title":"Left Atrial Appendage Closure for Stroke Prevention in Atrial Fibrillation: Current Status and Perspectives","volume":"45","author":"Landmesser U.","year":"2024","journal-title":"European Heart Journal"},{"key":"e_1_2_11_24_1","first-page":"69","article-title":"Clinical Outcomes Associated with Left Atrial Appendage Occlusion versus Direct Oral Anticoagulation in Atrial Fibrillation","volume":"14","author":"Nielsen\u2010Kudsk J. E.","year":"2021","journal-title":"JACC: Cardiovascular Interventions"},{"key":"e_1_2_11_25_1","first-page":"2139","article-title":"Impact of Device Implant Depth after Left Atrial Appendage Occlusion","volume":"16","author":"Cepas\u2010Guill\u00e9n P.","year":"2023","journal-title":"JACC: Cardiovascular Interventions"},{"key":"e_1_2_11_26_1","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1016\/j.ahj.2004.06.032","article-title":"Asymptomatic Atrial Fibrillation: Demographic Features and Prognostic Information from the Atrial Fibrillation Follow\u2010up Investigation of Rhythm Management (AFFIRM) Study","volume":"149","author":"Flaker G. C.","year":"2005","journal-title":"American Heart Journal"},{"key":"e_1_2_11_27_1","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1016\/j.hrthm.2018.11.017","article-title":"Epicardial Connection between the Right\u2010Sided Pulmonary Venous Carina and the Right Atrium in Patients with Atrial Fibrillation: a Possible Mechanism for Preclusion of Pulmonary Vein Isolation without Carina Ablation","volume":"16","author":"Yoshida K.","year":"2019","journal-title":"Heart Rhythm"},{"key":"e_1_2_11_28_1","doi-asserted-by":"crossref","first-page":"2452","DOI":"10.1111\/jce.16084","article-title":"Predictors of Pulmonary Vein Non\u2010Reconnection in the Second Procedure After Ablation Index\u2010Guided Pulmonary Vein Isolation for Atrial Fibrillation and Its Impact on the Outcome","volume":"34","author":"Okamatsu H.","year":"2023","journal-title":"Journal of Cardiovascular Electrophysiology"},{"key":"e_1_2_11_29_1","first-page":"602","article-title":"Pulmonary Vein Re\u2010Isolation as a Routine Strategy Regardless of Symptoms: the PRESSURE Randomized Controlled Trial","volume":"3","author":"Das M.","year":"2017","journal-title":"JACC: Clinical Electrophysiology"}],"container-title":["Pacing and Clinical Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70363","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/pace.70363","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70363","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T11:05:06Z","timestamp":1784113506000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pace.70363"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,15]]},"references-count":28,"alternative-id":["10.1111\/pace.70363"],"URL":"https:\/\/doi.org\/10.1111\/pace.70363","archive":["Portico"],"relation":{},"ISSN":["0147-8389","1540-8159"],"issn-type":[{"value":"0147-8389","type":"print"},{"value":"1540-8159","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,15]]},"assertion":[{"value":"2026-05-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"pace.70363"}}