{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T13:13:00Z","timestamp":1788441180124,"version":"build-2803163510"},"reference-count":62,"publisher":"IMR Press","issue":"8","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Cardiovasc. Med."],"abstract":"<jats:p>Atrial fibrillation (AF) is becoming increasingly prevalent worldwide because of population aging and the widespread availability of continuous rhythm monitoring. While medical therapy remains central to management, several procedural strategies are being considered for older patients, including catheter ablation with pulsed field ablation (PFA), atrioventricular node ablation with conduction system pacing (CSP), leadless pacemaker (LPM) implantation, and percutaneous left atrial appendage occlusion (LAAO). Catheter ablation is an established therapy that reduces AF burden and improves quality of life; however, the role of catheter ablation in older patients has historically been limited by higher complication rates and greater arrhythmia recurrence. The emergence of PFA may expand the role of ablation because of its procedural efficiency and favorable safety profile, although randomized data in older patients remain limited. A pace-and-ablate strategy with CSP offers an alternative for older patients with symptomatic persistent AF or tachy-brady syndrome. Indeed, by engaging the native conduction system, CSP provides more physiological ventricular activation and may reduce the risk of pacing-induced cardiomyopathy. LPMs avoid the lead- and pocket-related complications associated with transvenous pacemakers and may be especially advantageous in frail older patients with multiple comorbidities. LAAO is a potential strategy for stroke prevention that is often proposed for patients unable to tolerate long-term anticoagulation, although randomized data remain conflicting. This narrative review evaluates the current evidence supporting these procedures in older patients with AF.<\/jats:p>","DOI":"10.31083\/rcm51902","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T12:17:46Z","timestamp":1788437866000},"source":"Crossref","is-referenced-by-count":0,"title":["Procedural Management of Atrial Fibrillation in Older Patients"],"prefix":"10.31083","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3206-5725","authenticated-orcid":true,"given":"Francis Jonathan","family":"Ha","sequence":"first","affiliation":[{"name":"Victorian Heart Institute and Victorian Heart Hospital, Monash University, Monash Health, Clayton, VIC 3168, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2202-7278","authenticated-orcid":true,"given":"Yan","family":"Zhao","sequence":"additional","affiliation":[{"name":"Victorian Heart Institute and Victorian Heart Hospital, Monash University, Monash Health, Clayton, VIC 3168, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5884-5784","authenticated-orcid":true,"given":"Hui-Chen","family":"Han","sequence":"additional","affiliation":[{"name":"Victorian Heart Institute and Victorian Heart Hospital, Monash University, Monash Health, Clayton, VIC 3168, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4531-6052","authenticated-orcid":true,"given":"Adam J","family":"Brown","sequence":"additional","affiliation":[{"name":"Victorian Heart Institute and Victorian Heart Hospital, Monash University, Monash Health, Clayton, VIC 3168, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3437-8648","authenticated-orcid":true,"given":"Nitesh","family":"Nerlekar","sequence":"additional","affiliation":[{"name":"Victorian Heart Institute and Victorian Heart Hospital, Monash University, Monash Health, Clayton, VIC 3168, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0604-7825","authenticated-orcid":true,"given":"Emily","family":"Kotschet","sequence":"additional","affiliation":[{"name":"Victorian Heart Institute and Victorian Heart Hospital, Monash University, Monash Health, Clayton, VIC 3168, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"16242","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Lubitz SA, Faranesh AZ, Selvaggi C, Atlas SJ, McManus DD, Singer DE, et al. Detection of Atrial Fibrillation in a Large Population Using Wearable Devices: The Fitbit Heart Study. Circulation. 2022; 146: 1415\u20131424.","DOI":"10.1161\/CIRCULATIONAHA.122.060291"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"van Steijn NJ, Blommestijn IS, Blok S, Pepplinkhuizen S, Somsen GA, Knops RE, et al. Enhanced Detection and Prompt Diagnosis of Atrial Fibrillation Using Apple Watch: A Randomized Controlled Trial. Journal of the American College of Cardiology. 2026; 87: 1714\u20131728.","DOI":"10.1016\/j.jacc.2025.11.032"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"D'Angelo RN, Rong Y, Khanna R, Locke A, Iglesias M, d'Avila A, et al. Antiarrhythmic drugs vs catheter ablation for treatment of atrial fibrillation in an elderly population: A retrospective analysis of Medicare Advantage enrollees in the United States. Heart Rhythm. 2026; 23: e980\u2013e989.","DOI":"10.1016\/j.hrthm.2026.02.045"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Dulai R, Sulke N, Freemantle N, Lambiase PD, Farwell D, Srinivasan NT, et al. Pulmonary Vein Isolation vs Sham Intervention in Symptomatic Atrial Fibrillation: The SHAM-PVI Randomized Clinical Trial. JAMA. 2024; 332: 1165\u20131173.","DOI":"10.1001\/jama.2024.17921"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, et al. 2023 ACC\/AHA\/ACCP\/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024; 149: e1\u2013e156.","DOI":"10.1161\/CIR.0000000000001193"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Marrouche NF, Brachmann J, Andresen D, Siebels J, Boersma L, Jordaens L, et al. Catheter Ablation for Atrial Fibrillation with Heart Failure. The New England Journal of Medicine. 2018; 378: 417\u2013427.","DOI":"10.1056\/NEJMoa1707855"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Sohns C, Fox H, Marrouche NF, Crijns HJGM, Costard-Jaeckle A, Bergau L, et al. Catheter Ablation in End-Stage Heart Failure with Atrial Fibrillation. The New England Journal of Medicine. 2023; 389: 1380\u20131389.","DOI":"10.1056\/NEJMoa2306037"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Packer DL, Mark DB, Robb RA, Monahan KH, Bahnson TD, Poole JE, et al. Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality, Stroke, Bleeding, and Cardiac Arrest Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial. JAMA. 2019; 321: 1261\u20131274.","DOI":"10.1001\/jama.2019.0693"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Lee WC, Wu PJ, Chen HC, Fang HY, Liu PY, Chen MC. Efficacy and Safety of Ablation for Symptomatic Atrial Fibrillation in Elderly Patients: A Meta-Analysis. Frontiers in Cardiovascular Medicine. 2021; 8: 734204.","DOI":"10.3389\/fcvm.2021.734204"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Boehmer AA, Rothe M, Ruckes C, Eckardt L, Kaess BM, Ehrlich JR. Catheter Ablation for Atrial Fibrillation in Elderly Patients: an Updated Meta-analysis of Comparative Studies. The Canadian Journal of Cardiology. 2024; 40: 2441\u20132451.","DOI":"10.1016\/j.cjca.2024.08.263"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Fusco A, Hansen ML, Ruwald MH, Z\u00f6rner CR, Riis-Vestergaard L, Middelfart C, et al. Temporal Trends in Atrial Fibrillation Ablation in the Elderly: Incidence of MACE and Recurrence Rates. JACC. Clinical Electrophysiology. 2025; 11: 83\u201394.","DOI":"10.1016\/j.jacep.2024.09.024"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Ha FJ, Han HC, Nerlekar N, Brown AJ, Kotschet E. Advent of Pulsed Field Ablation for Atrial Fibrillation: State-of-the-Art Review. Reviews in Cardiovascular Medicine. 2025; 26: 47497.","DOI":"10.31083\/RCM47497"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Reddy VY, Gerstenfeld EP, Natale A, Whang W, Cuoco FA, Patel C, et al. Pulsed Field or Conventional Thermal Ablation for Paroxysmal Atrial Fibrillation. The New England Journal of Medicine. 2023; 389: 1660\u20131671.","DOI":"10.1056\/NEJMoa2307291"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Reichlin T, Kueffer T, Badertscher P, J\u00fcni P, Knecht S, Thalmann G, et al. Pulsed Field or Cryoballoon Ablation for Paroxysmal Atrial Fibrillation. The New England Journal of Medicine. 2025; 392: 1497\u20131507.","DOI":"10.1056\/NEJMoa2502280"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"Jais P, Neuzil P, Scherr D, Frison E, Knecht S, Boveda S, et al. Pulsed field vs radiofrequency ablation for paroxysmal atrial fibrillation: the BEAT PAROX-AF trial. European Heart Journal. 2026; 47: 1527\u20131537.","DOI":"10.1093\/eurheartj\/ehaf1115"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"Anter E, Mansour M, Nair DG, Sharma D, Taigen TL, Neuzil P, et al. Dual-energy lattice-tip ablation system for persistent atrial fibrillation: a randomized trial. Nature Medicine. 2024; 30: 2303\u20132310.","DOI":"10.1038\/s41591-024-03022-6"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"Men\u00e9 R, Sousonis V, Schmidt B, Bordignon S, Neven K, Reichlin T, et al. Safety and efficacy of pulsed-field ablation for atrial fibrillation in the elderly: A EU-PORIA sub-analysis. International Journal of Cardiology. 2024; 417: 132522.","DOI":"10.1016\/j.ijcard.2024.132522"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"Dello Russo A, Willems S, Szeplaki G, Garcia-Bolao I, Vijgen J, Szegedi N, et al. Acute procedural outcomes of pulsed field ablation in elderly patients with atrial fibrillation: sub-analysis of the global FARADISE registry. Europace. 2025; 27: euaf085.428.","DOI":"10.1093\/europace\/euaf085.428"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"Dello Russo A, Tondo C, Bianchi S, Schillaci V, Iacopino S, Casella M, et al. Does Age Impact Safety and Efficacy During Pulse-Field Ablation for Atrial Fibrillation? Journal of the American Heart Association. 2025; 14: e037959.","DOI":"10.1161\/JAHA.124.037959"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"Ha FJ, Prinsloo D, Han HC, Nerlekar N, Brown AJ, Kotschet E. Safety and Efficacy of Pulsed Field Ablation for Atrial Fibrillation in Older Patients: An Observational Study at a Large Tertiary Centre in Australia. Journal of Arrhythmia. 2026; 42: e70336.","DOI":"10.1002\/joa3.70336"},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"Ha FJ, Ermongkonchai T, Han HC, Nerlekar N, Brown AJ, Kotschet E. A Review of Potential Complications of Pulsed Field Ablation for AF: Beneath the Surface. Arrhythmia & Electrophysiology Review. 2026; 15: e13.","DOI":"10.15420\/aer.2025.54"},{"key":"ref22","doi-asserted-by":"publisher","unstructured":"Shiomi S, Tokuda M, Takato U, Sakurai R, Yamazaki Y, Matsumoto T, et al. Real-time detection of microembolic signals using carotid echocardiography: A comparative study of 3 pulsed-field systems. Heart Rhythm. 2026; 23: 25\u201331.","DOI":"10.1016\/j.hrthm.2025.06.046"},{"key":"ref23","doi-asserted-by":"publisher","unstructured":"Laskov V, Hozman M, Malikova H, Lauer D, Kremenova K, Herman D, et al. Cerebrovascular Ischemic Lesions After Pulsed Field Ablation for Atrial Fibrillation Using Variable-Loop Ablation Catheter. JACC. Clinical Electrophysiology. 2026; 12: 814\u2013823.","DOI":"10.1016\/j.jacep.2025.12.018"},{"key":"ref24","doi-asserted-by":"publisher","unstructured":"Dashwood A, Ha FJ, Healy S, Puchalski R, Cheng SH, Tian B, et al. Vascular Closure Device Following Pulsed Field Ablation for Atrial Fibrillation: A Randomized Controlled Trial. Pacing and Clinical Electrophysiology: PACE. 2025; 48: 1294\u20131300.","DOI":"10.1111\/pace.70051"},{"key":"ref25","doi-asserted-by":"publisher","unstructured":"Reddy VY, Gerstenfeld EP, Mountantonakis SE, Patel C, Ellenbogen KA, Harding JD, et al. Pulsed field ablation versus conventional thermal ablation for paroxysmal atrial fibrillation: 4-year outcomes in the ADVENT-LTO study. Nature Medicine. 2026; 32: 1444\u20131453.","DOI":"10.1038\/s41591-026-04246-4"},{"key":"ref26","doi-asserted-by":"publisher","unstructured":"Matteucci A, Russo M, Galeazzi M, Pandozi C, Bonanni M, Mariani MV, et al. Impact of Ablation Energy Sources on Perceived Quality of Life and Symptom in Atrial Fibrillation Patients: A Comparative Study. Journal of Clinical Medicine. 2025; 14: 2741.","DOI":"10.3390\/jcm14082741"},{"key":"ref27","doi-asserted-by":"publisher","unstructured":"Kim D, Shim J, Choi EK, Oh IY, Kim J, Lee YS, et al. Long-Term Anticoagulation Discontinuation After Catheter Ablation for Atrial Fibrillation: The ALONE-AF Randomized Clinical Trial. JAMA. 2025; 334: 1246\u20131254.","DOI":"10.1001\/jama.2025.14679"},{"key":"ref28","doi-asserted-by":"publisher","unstructured":"Verma A, Birnie DH, Jiang C, Heidb\u00fcchel H, Hindricks G, Kirchhof P, et al. Antithrombotic Therapy after Successful Catheter Ablation for Atrial Fibrillation. The New England Journal of Medicine. 2026; 394: 323\u2013332.","DOI":"10.1056\/NEJMoa2509688"},{"key":"ref29","doi-asserted-by":"publisher","unstructured":"Joza J, Burri H, Andrade JG, Linz D, Ellenbogen KA, Vernooy K. Atrioventricular node ablation for atrial fibrillation in the era of conduction system pacing. European Heart Journal. 2024; 45: 4887\u20134901.","DOI":"10.1093\/eurheartj\/ehae656"},{"key":"ref30","doi-asserted-by":"publisher","unstructured":"Somma V, Ha FJ, Palmer S, Mohamed U, Agarwal S. Pacing-induced cardiomyopathy: A systematic review and meta-analysis of definition, prevalence, risk factors, and management. Heart Rhythm. 2023; 20: 282\u2013290.","DOI":"10.1016\/j.hrthm.2022.09.019"},{"key":"ref31","doi-asserted-by":"publisher","unstructured":"Ha FJ. A new horizon for pacing-induced cardiomyopathy. Trends in Cardiovascular Medicine. 2026; 36: 357\u2013358.","DOI":"10.1016\/j.tcm.2026.02.005"},{"key":"ref32","doi-asserted-by":"publisher","unstructured":"Vijayaraman P, Subzposh FA, Naperkowski A. Atrioventricular node ablation and His bundle pacing. Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology: Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology. 2017; 19: iv10\u2013iv16.","DOI":"10.1093\/europace\/eux263"},{"key":"ref33","doi-asserted-by":"publisher","unstructured":"Shroff JP, Raja DC, Abhilash SP, Mehta A, Abhayaratna WP, Vijayaraman P, et al. Left bundle branch area pacing vs right ventricular pacing in preserved or mildly reduced ejection fraction: the PACE-HF trial. European Heart Journal. 2026; 47: 3298\u20133300.","DOI":"10.1093\/eurheartj\/ehaf724"},{"key":"ref34","doi-asserted-by":"publisher","unstructured":"Curila K, Mizner J, Morava J, Smisek R, Vesela J, Sussenbek O, et al. Prospective randomized trial of conduction system pacing vs right ventricular pacing for patients with atrioventricular block; Prague CSP trial. Heart Rhythm. 2025; 22: e894\u2013e902.","DOI":"10.1016\/j.hrthm.2025.05.036"},{"key":"ref35","doi-asserted-by":"publisher","unstructured":"Chow CLD, Wong C, Sutherland N, Obeyesekere MN, Wong GR, Eastwood CM, et al. Clinical Outcomes of Conduction System Pacing vs Right Ventricular Septal Pacing in Atrioventricular Block: The CSPACE Randomized Controlled Trial. Journal of the American College of Cardiology. 2025; 86: 563\u2013573.","DOI":"10.1016\/j.jacc.2025.06.043"},{"key":"ref36","doi-asserted-by":"publisher","unstructured":"Gonz\u00e1lez-Matos CE, Rodr\u00edguez-Queralto O, Z\u00e1raket F, Jim\u00e9nez J, Casteigt B, Vall\u00e8s E. Conduction System Stimulation to Avoid Left Ventricle Dysfunction. Circulation. Arrhythmia and Electrophysiology. 2024; 17: e012473.","DOI":"10.1161\/CIRCEP.123.012473"},{"key":"ref37","doi-asserted-by":"publisher","unstructured":"Brignole M, Pentimalli F, Palmisano P, Landolina M, Quartieri F, Occhetta E, et al. AV junction ablation and cardiac resynchronization for patients with permanent atrial fibrillation and narrow QRS: the APAF-CRT mortality trial. European Heart Journal. 2021; 42: 4731\u20134739.","DOI":"10.1093\/eurheartj\/ehab569"},{"key":"ref38","doi-asserted-by":"publisher","unstructured":"Rodr\u00edguez Mu\u00f1oz D, Crespo-Leiro MG, Fern\u00e1ndez Lozano I, Zamorano G\u00f3mez JL, Peinado Peinado R, Manzano Espinosa L, et al. Conduction system pacing and atrioventricular node ablation in heart failure: The PACE-FIB study design. ESC Heart Failure. 2023; 10: 3700\u20133709.","DOI":"10.1002\/ehf2.14488"},{"key":"ref39","doi-asserted-by":"publisher","unstructured":"Boehmer AA, Kaess BM, Ruckes C, Meyer C, Metzner A, Rillig A, et al. Pulmonary Vein Isolation or Pace and Ablate in Elderly Patients With Persistent Atrial Fibrillation (ABLATE Versus PACE)-Rationale, Methods, and Design. The Canadian Journal of Cardiology. 2024; 40: 2429\u20132440.","DOI":"10.1016\/j.cjca.2024.07.021"},{"key":"ref40","doi-asserted-by":"publisher","unstructured":"De Pooter J, Breitenstein A, \u00d6zpak E, Haeberlin A, Hofer D, Le Polain de Waroux JB, et al. Lead Integrity and Failure Evaluation in Left Bundle Branch Area Pacing: The LIFE-LBBAP Study. JACC. Clinical Electrophysiology. 2025; 11: 158\u2013170.","DOI":"10.1016\/j.jacep.2024.09.020"},{"key":"ref41","doi-asserted-by":"publisher","unstructured":"G\u00e9mesi M, Polg\u00e1r B, Gingl Z, Marczell I, Zsigmond EJ, Chityil-Papp L, et al. Kinetics and Disappearance of QRS Transition in Patients Undergoing Left Bundle Branch Pacing - A Novel Method for Classifying Microdislodgement. Journal of Cardiovascular Electrophysiology. 2025; 36: 2254\u20132263.","DOI":"10.1111\/jce.16779"},{"key":"ref42","doi-asserted-by":"publisher","unstructured":"Boersma LV, El-Chami M, Steinwender C, Lambiase P, Murgatroyd F, Mela T, et al. Practical considerations, indications, and future perspectives for leadless and extravascular cardiac implantable electronic devices: a position paper by EHRA\/HRS\/LAHRS\/APHRS. Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology: Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology. 2022; 24: 1691\u20131708.","DOI":"10.1093\/europace\/euac066"},{"key":"ref43","doi-asserted-by":"publisher","unstructured":"Reynolds D, Duray GZ, Omar R, Soejima K, Neuzil P, Zhang S, et al. A Leadless Intracardiac Transcatheter Pacing System. The New England Journal of Medicine. 2016; 374: 533\u2013541.","DOI":"10.1056\/NEJMoa1511643"},{"key":"ref44","doi-asserted-by":"publisher","unstructured":"Reddy VY, Exner DV, Doshi R, Tomassoni G, Bunch TJ, Friedman P, et al. 1-Year Outcomes of a Leadless Ventricular Pacemaker: The LEADLESS II (Phase 2) Trial. JACC. Clinical Electrophysiology. 2023; 9: 1187\u20131189.","DOI":"10.1016\/j.jacep.2023.01.031"},{"key":"ref45","doi-asserted-by":"publisher","unstructured":"El-Chami MF, Garweg C, Clementy N, Al-Samadi F, Iacopino S, Martinez-Sande JL, et al. Leadless pacemakers at 5-year follow-up: the Micra transcatheter pacing system post-approval registry. European Heart Journal. 2024; 45: 1241\u20131251.","DOI":"10.1093\/eurheartj\/ehae101"},{"key":"ref46","doi-asserted-by":"publisher","unstructured":"Knops RE, Reddy VY, Ip JE, Doshi R, Exner DV, Defaye P, et al. A Dual-Chamber Leadless Pacemaker. The New England Journal of Medicine. 2023; 388: 2360\u20132370.","DOI":"10.1056\/NEJMoa2300080"},{"key":"ref47","doi-asserted-by":"publisher","unstructured":"Pagan E, Gabriels J, Khodak A, Chang D, Beldner S, Epstein LM, et al. Safety of leadless pacemaker implantation in the very elderly. Heart Rhythm. 2020; 17: 2023\u20132028.","DOI":"10.1016\/j.hrthm.2020.05.022"},{"key":"ref48","doi-asserted-by":"publisher","unstructured":"Sagoo NS, Sagoo R, Srinivasaraghavan A, Bose G, Haider AS, Charate R, et al. Impact of Advanced Age on In-Hospital Outcomes Following Leadless Pacemaker Implantation. Journal of Cardiovascular Electrophysiology. 2025; 36: 2151\u20132159.","DOI":"10.1111\/jce.16768"},{"key":"ref49","doi-asserted-by":"publisher","unstructured":"Boveda S, Higuera L, Longacre C, Wolff C, Wherry K, Stromberg K, et al. Two-year outcomes of leadless vs. transvenous single-chamber ventricular pacemaker in high-risk subgroups. Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology: Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology. 2023; 25: 1041\u20131050.","DOI":"10.1093\/europace\/euad016"},{"key":"ref50","doi-asserted-by":"publisher","unstructured":"Al-Shahi Salman R, Stephen J, Tierney JF, Lewis SC, Newby DE, Parry-Jones AR, et al. Effects of oral anticoagulation in people with atrial fibrillation after spontaneous intracranial haemorrhage (COCROACH): prospective, individual participant data meta-analysis of randomised trials. The Lancet. Neurology. 2023; 22: 1140\u20131149.","DOI":"10.1016\/S1474-4422(23)00315-0"},{"key":"ref51","doi-asserted-by":"publisher","unstructured":"Veltkamp R, Korompoki E, Harvey KH, Harvey ER, Fie\u00dfler C, Malzahn U, et al. Direct oral anticoagulants versus no anticoagulation for the prevention of stroke in survivors of intracerebral haemorrhage with atrial fibrillation (PRESTIGE-AF): a multicentre, open-label, randomised, phase 3 trial. Lancet (London, England). 2025; 405: 927\u2013936.","DOI":"10.1016\/S0140-6736(25)00333-2"},{"key":"ref52","doi-asserted-by":"publisher","unstructured":"Nielsen-Kudsk JE, Boersma LVA, Camm AJ. Left atrial appendage closure: a reappraisal of atrial fibrillation guidelines. European Heart Journal. 2025; 46: 3636\u20133638.","DOI":"10.1093\/eurheartj\/ehaf454"},{"key":"ref53","doi-asserted-by":"publisher","unstructured":"Holmes DR, Reddy VY, Turi ZG, Doshi SK, Sievert H, Buchbinder M, et al. Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial. Lancet (London, England). 2009; 374: 534\u2013542.","DOI":"10.1016\/S0140-6736(09)61343-X"},{"key":"ref54","doi-asserted-by":"publisher","unstructured":"Holmes DR Jr, Kar S, Price MJ, Whisenant B, Sievert H, Doshi SK, et al. Prospective randomized evaluation of the Watchman Left Atrial Appendage Closure device in patients with atrial fibrillation versus long-term warfarin therapy: the PREVAIL trial. Journal of the American College of Cardiology. 2014; 64: 1\u201312.","DOI":"10.1016\/j.jacc.2014.04.029"},{"key":"ref55","doi-asserted-by":"publisher","unstructured":"Osmancik P, Herman D, Neuzil P, Hala P, Taborsky M, Kala P, et al. Left Atrial Appendage Closure Versus Direct Oral Anticoagulants in High-Risk Patients With Atrial Fibrillation. Journal of the American College of Cardiology. 2020; 75: 3122\u20133135.","DOI":"10.1016\/j.jacc.2020.04.067"},{"key":"ref56","doi-asserted-by":"publisher","unstructured":"Landmesser U, Skurk C, Kirchhof P, Lewalter T, Hartung J, Rroku A, et al. Left Atrial Appendage Closure or Medical Therapy in Atrial Fibrillation. The New England Journal of Medicine. 2026; 394: 1270\u20131280.","DOI":"10.1056\/NEJMoa2513310"},{"key":"ref57","doi-asserted-by":"publisher","unstructured":"Doshi SK, Kar S, Nair DG, Waggoner T, Agarwal H, Moussavian M, et al. Left Atrial Appendage Closure or Anticoagulation for Atrial Fibrillation. The New England Journal of Medicine. 2026; 394: 2083\u20132094.","DOI":"10.1056\/NEJMoa2517213"},{"key":"ref58","doi-asserted-by":"publisher","unstructured":"Turagam MK, Reddy VY, Dukkipati SR. EWOLUTION of Watchman Left Atrial Appendage Closure to Patients With Contraindication to Oral Anticoagulation. Circulation. Arrhythmia and Electrophysiology. 2019; 12: e007257.","DOI":"10.1161\/CIRCEP.119.007257"},{"key":"ref59","doi-asserted-by":"publisher","unstructured":"Holmes DR, Reddy VY, Buchbinder M, Stein K, Elletson M, Bergmann MW, et al. The Assessment of the Watchman Device in Patients Unsuitable for Oral Anticoagulation (ASAP-TOO) trial. American Heart Journal. 2017; 189: 68\u201374.","DOI":"10.1016\/j.ahj.2017.03.007"},{"key":"ref60","doi-asserted-by":"publisher","unstructured":"Vedage NA, Friedman SF, Chang Y, Borowsky LH, Shah SJ, McManus DD, et al. Risk-Guided Atrial Fibrillation Screening With Artificial Intelligence-Enabled Electrocardiogram Models: A VITAL-AF Trial Analysis. Journal of the American College of Cardiology. 2026; 87: 1798\u20131813.","DOI":"10.1016\/j.jacc.2026.01.087"},{"key":"ref61","doi-asserted-by":"publisher","unstructured":"Proietti M, Lip GYH, Ainsworth J, Dan GA, Frost L, Graffigna G, et al. Integrated care management for older multimorbid patients with atrial fibrillation: Rationale, design and baseline characteristics for the atrial fibrillation integrated approach in frail, multimorbid and polymedicated older people (AFFIRMO) trial. American Heart Journal. 2026; 295: 107356.","DOI":"10.1016\/j.ahj.2026.107356"},{"key":"ref62","doi-asserted-by":"publisher","unstructured":"Armoundas AA, Narayan SM, Arnett DK, Spector-Bagdady K, Bennett DA, Celi LA, et al. Use of Artificial Intelligence in Improving Outcomes in Heart Disease: A Scientific Statement From the American Heart Association. Circulation. 2024; 149: e1028\u2013e1050.","DOI":"10.1161\/CIR.0000000000001201"}],"container-title":["Reviews in Cardiovascular Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.imrpress.com\/journal\/RCM\/27\/8\/10.31083\/RCM51902","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T12:18:21Z","timestamp":1788437901000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.imrpress.com\/journal\/RCM\/27\/8\/10.31083\/RCM51902"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,20]]},"references-count":62,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026]]}},"alternative-id":["S2153-8174(26)03634-0"],"URL":"https:\/\/doi.org\/10.31083\/rcm51902","relation":{},"ISSN":["1530-6550","2153-8174"],"issn-type":[{"value":"1530-6550","type":"print"},{"value":"2153-8174","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,20]]},"article-number":"51902"}}