{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T21:14:04Z","timestamp":1783718044061,"version":"3.55.0"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Arrhythmia and Electrophysiology"],"published-print":{"date-parts":[[2016,7]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>Left atrial appendage (LAA) electric isolation is reported to improve persistent atrial fibrillation (AF) ablation outcomes. However, loss of LAA mechanical function may increase thromboembolic risk. Concomitant LAA electric isolation and occlusion as part of conventional AF ablation has never been tested in humans. We therefore evaluated the feasibility, safety, and efficacy of LAA electric isolation and occlusion in patients undergoing long-standing persistent AF ablation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              Patients with long-standing persistent AF (age, 68\u00b17 years; left atrium diameter, 46\u00b13 mm; and AF duration, 25\u00b115 months) underwent AF ablation, LAA electric isolation, and occlusion. Outcomes were compared with a balanced (1:2 ratio) control group who had AF ablation alone. Among 22 patients who underwent ablation, LAA electric isolation was possible in 20. Intraprocedural LAA reconnection occurred in 17 of 20 (85%) patients, predominantly at anterior and superior locations. All were reisolated. LAA occlusion was successful in all 20 patients. There were no major periprocedural complications. Imaging at 45 days and 9 months confirmed satisfactory device position and excluded pericardial effusion. One of twenty (5%) patients had a gap of \u22655 mm requiring anticoagulation. Nineteen of twenty (95%) patients stopped warfarin at 3 months. Without antiarrhythmic drugs, freedom from AF at 12 months after a single procedure was significantly higher in the study group (19\/20, 95%) than in the control group (25\/40, 63%),\n              <jats:italic>P<\/jats:italic>\n              =0.036. Freedom from atrial arrhythmias was demonstrated in 12 of 20 (60%) and 18 of 20 (90%) patients after 1 and \u22642 procedures (mean, 1.3), respectively.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>Persistent AF ablation, LAA electric isolation, and mechanical occlusion can be performed concomitantly. This technique may improve the success of persistent AF ablation while obviating the need for chronic anticoagulation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical Trial Registration\u2014<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\">https:\/\/clinicaltrials.gov<\/jats:ext-link>\n              . Unique identifier: NCT02028130.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circep.115.003710","type":"journal-article","created":{"date-parts":[[2016,7,13]],"date-time":"2016-07-13T02:54:36Z","timestamp":1468378476000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":75,"title":["Left Atrial Appendage Electrical Isolation and Concomitant Device Occlusion to Treat Persistent Atrial Fibrillation"],"prefix":"10.1161","volume":"9","author":[{"given":"Sandeep","family":"Panikker","sequence":"first","affiliation":[{"name":"From the Heart Rhythm Centre, National Institute for Health Research (NIHR) Cardiovascular Research Unit, Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.P., J.W.E.J., S.H., C.B., H.K., L.M., E.N., J.P.F., V.M., T.W.); CV Path Institute, Gaithersburg, MD (R.V., R.K.); and Department of Cardiology, National Heart Centre Singapore, Singapore (E.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian W.E.","family":"Jarman","sequence":"additional","affiliation":[{"name":"From the Heart Rhythm Centre, National Institute for Health Research (NIHR) Cardiovascular Research Unit, Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.P., J.W.E.J., S.H., C.B., H.K., L.M., E.N., J.P.F., V.M., T.W.); CV Path Institute, Gaithersburg, MD (R.V., R.K.); and Department of Cardiology, National Heart Centre Singapore, Singapore (E.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renu","family":"Virmani","sequence":"additional","affiliation":[{"name":"From the Heart Rhythm Centre, National Institute for Health Research (NIHR) Cardiovascular Research Unit, Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.P., J.W.E.J., S.H., C.B., H.K., L.M., E.N., J.P.F., V.M., T.W.); CV Path Institute, Gaithersburg, MD (R.V., R.K.); and Department of Cardiology, National Heart Centre Singapore, Singapore (E.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Kutys","sequence":"additional","affiliation":[{"name":"From the Heart Rhythm Centre, National Institute for Health Research (NIHR) Cardiovascular Research Unit, Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.P., J.W.E.J., S.H., C.B., H.K., L.M., E.N., J.P.F., V.M., T.W.); CV Path Institute, Gaithersburg, MD (R.V., R.K.); and Department of Cardiology, National Heart Centre Singapore, Singapore (E.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shouvik","family":"Haldar","sequence":"additional","affiliation":[{"name":"From the Heart Rhythm Centre, National Institute for Health Research (NIHR) Cardiovascular Research Unit, Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.P., J.W.E.J., S.H., C.B., H.K., L.M., E.N., J.P.F., V.M., T.W.); CV Path Institute, Gaithersburg, MD (R.V., R.K.); and Department of Cardiology, National Heart Centre Singapore, Singapore (E.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Lim","sequence":"additional","affiliation":[{"name":"From the Heart Rhythm Centre, National Institute for Health Research (NIHR) Cardiovascular Research Unit, Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.P., J.W.E.J., S.H., C.B., H.K., L.M., E.N., J.P.F., V.M., T.W.); CV Path Institute, Gaithersburg, MD (R.V., R.K.); and Department of Cardiology, National Heart Centre Singapore, Singapore (E.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Butcher","sequence":"additional","affiliation":[{"name":"From the Heart Rhythm Centre, National Institute for Health Research (NIHR) Cardiovascular Research Unit, Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.P., J.W.E.J., S.H., C.B., H.K., L.M., E.N., J.P.F., V.M., T.W.); CV Path Institute, Gaithersburg, MD (R.V., R.K.); and Department of Cardiology, National Heart Centre Singapore, Singapore (E.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Habib","family":"Khan","sequence":"additional","affiliation":[{"name":"From the Heart Rhythm Centre, National Institute for Health Research (NIHR) Cardiovascular Research Unit, Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.P., J.W.E.J., S.H., C.B., H.K., L.M., E.N., J.P.F., V.M., T.W.); CV Path Institute, Gaithersburg, MD (R.V., R.K.); and Department of Cardiology, National Heart Centre Singapore, Singapore (E.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilian","family":"Mantziari","sequence":"additional","affiliation":[{"name":"From the Heart Rhythm Centre, National Institute for Health Research (NIHR) Cardiovascular Research Unit, Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.P., J.W.E.J., S.H., C.B., H.K., L.M., E.N., J.P.F., V.M., T.W.); CV Path Institute, Gaithersburg, MD (R.V., R.K.); and Department of Cardiology, National Heart Centre Singapore, Singapore (E.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Nicol","sequence":"additional","affiliation":[{"name":"From the Heart Rhythm Centre, National Institute for Health Research (NIHR) Cardiovascular Research Unit, Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.P., J.W.E.J., S.H., C.B., H.K., L.M., E.N., J.P.F., V.M., T.W.); CV Path Institute, Gaithersburg, MD (R.V., R.K.); and Department of Cardiology, National Heart Centre Singapore, Singapore (E.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John P.","family":"Foran","sequence":"additional","affiliation":[{"name":"From the Heart Rhythm Centre, National Institute for Health Research (NIHR) Cardiovascular Research Unit, Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.P., J.W.E.J., S.H., C.B., H.K., L.M., E.N., J.P.F., V.M., T.W.); CV Path Institute, Gaithersburg, MD (R.V., R.K.); and Department of Cardiology, National Heart Centre Singapore, Singapore (E.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vias","family":"Markides","sequence":"additional","affiliation":[{"name":"From the Heart Rhythm Centre, National Institute for Health Research (NIHR) Cardiovascular Research Unit, Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.P., J.W.E.J., S.H., C.B., H.K., L.M., E.N., J.P.F., V.M., T.W.); 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