{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T12:35:14Z","timestamp":1786624514574,"version":"build-2736575974"},"reference-count":14,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"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":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Percutaneous left atrial appendage occlusion (LAAO) is an alternative strategy for stroke prevention in patients with nonvalvular atrial fibrillation (AF) with contraindications to long\u2010term oral anticoagulation therapy. However, evidence comparing the long\u2010term outcomes of LAAO with those of direct oral anticoagulants (DOAC) remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic search was conducted across PubMed, Scopus, and the Cochrane databases through April 2026. Co\u2010primary outcomes were major adverse cardiovascular and cerebrovascular events (MACCE; composite of cardiac death, stroke, or systemic embolism) and net adverse clinical events (NACE; composite of MACCE and non\u2010procedure\u2010related bleeding). Secondary endpoints included individual components of co\u2010primary endpoints, ischemic and hemorrhagic stroke, all\u2010cause death, major or clinically significant bleeding (procedure + non\u2010procedure related), and stroke or systemic embolism. The random\u2010effects model was used to generate risk ratios (RRs) and 95% CIs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Four randomized controlled trials comprising 5890 AF patients and a median follow\u2010up of 3 years were included. There was no significant difference between LAAO and DOAC therapy in the risk of MACCE (RR 1.17; 95%CI 0.96\u20131.41;\n                      <jats:italic>\n                        I\n                        <jats:sup>2<\/jats:sup>\n                      <\/jats:italic>\n                      \u00a0=\u00a00%) or NACE (RR 0.89; 95%CI 0.65\u20131.24;\n                      <jats:italic>\n                        I\n                        <jats:sup>2<\/jats:sup>\n                      <\/jats:italic>\n                      \u00a0=\u00a085%). Both LAAO and DOAC therapy were similar in risk of cardiac death, stroke, systemic embolism, hemorrhagic stroke, ischemic stroke, all\u2010cause mortality, stroke or systemic embolism, and pericardial effusion. LAAO was associated with a lower risk of non\u2010procedure\u2010related bleeding (RR 0.60; 95%CI 0.47\u20130.76;\n                      <jats:italic>\n                        I\n                        <jats:sup>2<\/jats:sup>\n                      <\/jats:italic>\n                      \u00a0=\u00a059%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>LAAO demonstrated efficacy comparable to DOAC therapy in reducing the risk of MACCE, NACE, and ischemic events, while significantly reducing the risk of non\u2010procedure\u2010related bleeding. Our findings support a tailored approach to stroke prevention in AF, wherein LAAO serves as an effective alternative for patients with contraindications to DOAC therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pace.70395","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T12:05:30Z","timestamp":1786622730000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Long\u2010Term Outcomes of LAAO Versus DOACs in Nonvalvular Atrial Fibrillation: A Meta\u2010Analysis of Randomized Trials"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-3988-6211","authenticated-orcid":false,"given":"Chidubem","family":"Ezenna","sequence":"first","affiliation":[{"name":"Department of Medicine University of Massachusetts \u2013 Baystate Medical Center  Springfield Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2643-0434","authenticated-orcid":false,"given":"Khalid","family":"Sawalha","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Baystate Medical Center and Division of Cardiovascular Medicine, University of Massachusetts\u2010Baystate  Springfield Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5039-8174","authenticated-orcid":false,"given":"Sammudeen","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic  Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8894-4443","authenticated-orcid":false,"given":"Mrinal Murali","family":"Krishna","sequence":"additional","affiliation":[{"name":"Department of Medicine Medical College Thiruvananthapuram  Thiruvananthapuram Kerala India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5422-2605","authenticated-orcid":false,"given":"Meghna","family":"Joseph","sequence":"additional","affiliation":[{"name":"Department of Medicine Medical College Thiruvananthapuram  Thiruvananthapuram Kerala India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1973-8646","authenticated-orcid":false,"given":"Lakshmi Sai Niharika","family":"Janga","sequence":"additional","affiliation":[{"name":"Department of Medicine Mount Auburn Hospital\u2010Havard Medical School  Cambridge Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samia","family":"Nadeem","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Massachusetts \u2013 Baystate Medical Center  Springfield Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8187-8847","authenticated-orcid":false,"given":"Abdul\u2010Daaim","family":"Mohammed\u2010Murtala","sequence":"additional","affiliation":[{"name":"Department of Radiology 37 Military Hospital  Accra Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6898-2192","authenticated-orcid":false,"given":"Raiza","family":"Rossi","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2952-7837","authenticated-orcid":false,"given":"Andrew M.","family":"Goldsweig","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Baystate Medical Center and Division of Cardiovascular Medicine, University of Massachusetts\u2010Baystate  Springfield Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001193"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.15192"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.04.029"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.10.021"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpcardiol.2024.102880"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2022.08.012"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.122.062765"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2517213"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2513310"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g7647"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1186"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.10.023"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2408308"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2015.08.035"}],"container-title":["Pacing and Clinical Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70395","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/pace.70395","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70395","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T12:05:31Z","timestamp":1786622731000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pace.70395"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,13]]},"references-count":14,"alternative-id":["10.1111\/pace.70395"],"URL":"https:\/\/doi.org\/10.1111\/pace.70395","archive":["Portico"],"relation":{},"ISSN":["0147-8389","1540-8159"],"issn-type":[{"value":"0147-8389","type":"print"},{"value":"1540-8159","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,13]]},"assertion":[{"value":"2026-05-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"pace.70395"}}