{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T12:30:38Z","timestamp":1787574638652,"version":"build-2736575974"},"reference-count":77,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with ischemic stroke, systemic thromboembolism, heart failure, and mortality. Although oral anticoagulation (OAC) remains the cornerstone of stroke prevention, long-term therapy may be limited by bleeding risk, contraindications, intolerance, nonadherence, or thromboembolic events despite treatment. Left atrial appendage closure (LAAC) has therefore emerged as a non-pharmacological alternative for selected patients with nonvalvular AF. This review aimed to synthesize current evidence on LAAC, focusing on comparative efficacy versus OAC, device evolution, imaging-guided strategies, antithrombotic management, procedural optimization, unresolved challenges, and emerging technologies. Methods: This state-of-the-art narrative review was informed by targeted, non-systematic searches of PubMed and Scopus for publications from January 2009 to June 2026. Evidence was selected purposively to represent clinically relevant guidelines, randomized trials, registries, comparative observational studies, systematic reviews, meta-analyses, imaging studies, device-comparison studies, and reports of emerging technologies. The selected evidence was synthesized narratively; no exhaustive screening process, PRISMA flow diagram, formal risk-of-bias assessment, or quantitative synthesis was performed. Results: Randomized evidence was context dependent. OPTION supported LAAC as an alternative to oral anticoagulation in selected anticoagulation-eligible patients undergoing atrial fibrillation ablation. CHAMPION-AF established noninferiority of Watchman FLX to non\u2013vitamin K antagonist oral anticoagulants for its composite efficacy endpoint in a predominantly moderate-risk, anticoagulation-eligible population and demonstrated less non-procedural bleeding, although ischemic stroke occurred numerically more often after LAAC. In contrast, CLOSURE-AF did not establish noninferiority of LAAC to physician-directed medical therapy in an older population at high risks of both stroke and bleeding. These findings indicate that the comparative value of LAAC depends strongly on patient selection, comparator therapy, endpoint composition, procedural risk, and trial design. Observational, registry, and emerging evidence was considered supportive or hypothesis-generating rather than equivalent to randomized evidence. OPTION enrolled only patients undergoing or recently undergoing AF ablation who were suitable for anticoagulation. CHAMPION-AF included 3000 anticoagulation-eligible patients but had relatively low baseline bleeding risk, while CLOSURE-AF studied 912 substantially older, higher-risk patients and did not meet its noninferiority criterion. Conclusions: LAAC has evolved into a precision-guided intervention integrating patient risk, left atrial appendage anatomy, device choice, imaging, antithrombotic therapy, and structured surveillance. Further studies are needed to optimize patient selection, standardize post-procedural therapy, and clarify its long-term role compared with contemporary direct oral anticoagulant therapy.<\/jats:p>","DOI":"10.3390\/jcm15176526","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T11:47:19Z","timestamp":1787572039000},"page":"6526","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Next Frontiers in Stroke Prevention: Optimizing Left Atrial Appendage Closure in Atrial Fibrillation: Current Devices, Imaging-Guided Strategies, and Emerging Approaches"],"prefix":"10.3390","volume":"15","author":[{"given":"Zain Al-Abdeen Mohammed","family":"Qassim","sequence":"first","affiliation":[{"name":"RAK College of Medical Sciences, Ras Al Khaimah Medical and Health Sciences University (RAKMHSU), Ras Al Khaimah 11172, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6948-3619","authenticated-orcid":false,"given":"Mohamedanas Mohamedfaruk","family":"Patni","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, RAK College of Medical Sciences, Ras Al Khaimah Medical and Health Sciences University (RAKMHSU), Ras Al Khaimah 11172, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5029-7779","authenticated-orcid":false,"given":"Biji Thomas","family":"George","sequence":"additional","affiliation":[{"name":"Department of Surgery, RAK College of Medical Sciences, Ras Al Khaimah Medical and Health Sciences University (RAKMHSU), Ras Al Khaimah 11172, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9379-7447","authenticated-orcid":false,"given":"Subhranshu Sekhar","family":"Kar","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, RAK College of Medical Sciences, Ras Al Khaimah Medical and Health Sciences University (RAKMHSU), Ras Al Khaimah 11172, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1539-6162","authenticated-orcid":false,"given":"Rajani","family":"Dube","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, RAK College of Medical Sciences, Ras Al Khaimah Medical and Health Sciences University (RAKMHSU), Ras Al Khaimah 11172, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reema Mohammed Saeed","family":"Al Shaibani","sequence":"additional","affiliation":[{"name":"RAK College of Medical Sciences, Ras Al Khaimah Medical and Health Sciences University (RAKMHSU), Ras Al Khaimah 11172, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghina Hasan","family":"Yassin","sequence":"additional","affiliation":[{"name":"RAK College of Medical Sciences, Ras Al Khaimah Medical and Health Sciences University (RAKMHSU), Ras Al Khaimah 11172, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yara Mamoun","family":"Theyabat","sequence":"additional","affiliation":[{"name":"RAK College of Medical Sciences, Ras Al Khaimah Medical and Health Sciences University (RAKMHSU), Ras Al Khaimah 11172, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6854-7041","authenticated-orcid":false,"given":"Ibrahim","family":"Alabid","sequence":"additional","affiliation":[{"name":"RAK College of Medical Sciences, Ras Al Khaimah Medical and Health Sciences University (RAKMHSU), Ras Al Khaimah 11172, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malak Mohammed","family":"Qassim","sequence":"additional","affiliation":[{"name":"RAK College of Medical Sciences, Ras Al Khaimah Medical and Health Sciences University (RAKMHSU), Ras Al Khaimah 11172, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"key":"ref_1","first-page":"103783","article-title":"2025 SCAI\/HRS clinical practice guidelines on transcatheter left atrial appendage occlusion","volume":"4","author":"Goldsweig","year":"2025","journal-title":"J. Soc. Cardiovasc. Angiogr. Interv."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/j.jjcc.2025.01.014","article-title":"Current evidence and indications for left atrial appendage closure","volume":"85","author":"Shinohara","year":"2025","journal-title":"J. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1007\/s12928-025-01222-6","article-title":"Left atrial appendage closure: Current status, unresolved issues, and future perspectives","volume":"41","author":"Kondo","year":"2026","journal-title":"Cardiovasc. Interv. Ther."},{"key":"ref_4","first-page":"e248511","article-title":"Left atrial appendage occlusion: Current landscape and future direction","volume":"51","author":"Zia","year":"2024","journal-title":"Tex. Heart Inst. J."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Pastormerlo, L.E., De Caterina, A.R., Esposito, A., Korsholm, K., and Berti, S. (2024). State-of-the-art of transcatheter left atrial appendage occlusion. J. Clin. Med., 13.","DOI":"10.3390\/jcm13040939"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Barletta, V., Alberti, M., Agostini, R., Pizzino, F., Trimarchi, G., D\u2019Alfonso, M.G., Solari, M., Zucchelli, G., and Cresti, A. (2025). Optimizing imaging techniques for left atrial appendage closure: Insights and emerging directions. J. Clin. Med., 14.","DOI":"10.3390\/jcm14103607"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Kramer, A., Patti, G., Nielsen-Kudsk, J.E., Berti, S., and Korsholm, K. (2024). Left atrial appendage occlusion and post-procedural antithrombotic management. J. Clin. Med., 13.","DOI":"10.3390\/jcm13030803"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1016\/S0140-6736(09)61343-X","article-title":"Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: A randomised non-inferiority trial","volume":"374","author":"Holmes","year":"2009","journal-title":"Lancet"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jacc.2014.04.029","article-title":"Prospective randomized evaluation of the Watchman Left Atrial Appendage Closure device in patients with atrial fibrillation versus long-term warfarin therapy: The PREVAIL trial","volume":"64","author":"Holmes","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2081","DOI":"10.1056\/NEJMoa2101897","article-title":"Left atrial appendage occlusion during cardiac surgery to prevent stroke","volume":"384","author":"Whitlock","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1543","DOI":"10.1161\/CIRCULATIONAHA.121.057063","article-title":"Amplatzer Amulet left atrial appendage occluder versus Watchman device for stroke prophylaxis (Amulet IDE): A randomized, controlled trial","volume":"144","author":"Lakkireddy","year":"2021","journal-title":"Circulation"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1161\/CIRCULATIONAHA.121.057859","article-title":"Amulet or Watchman device for percutaneous left atrial appendage closure: Primary results of the SWISS-APERO randomized clinical trial","volume":"145","author":"Galea","year":"2022","journal-title":"Circulation"},{"key":"ref_13","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","year":"2025","journal-title":"N. Engl. J. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2585","DOI":"10.1016\/j.hrthm.2025.04.029","article-title":"Comparison of left atrial appendage closure and oral anti-coagulation after catheter ablation for atrial fibrillation: Concomitant and sequential cohorts of the OPTION randomized controlled trial","volume":"22","author":"Saliba","year":"2025","journal-title":"Heart Rhythm"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1016\/j.jacep.2025.09.030","article-title":"Atrial fibrillation recurrence after left atrial appendage occlusion in patients undergoing ablation: The OPTION trial sub-analysis","volume":"12","author":"Younis","year":"2026","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"euaf085.515","DOI":"10.1093\/europace\/euaf085.515","article-title":"Comparison of outcomes between males and females treated with left atrial appendage closure or oral anticoagulation after catheter ablation for atrial fibrillation: An OPTION subanalysis","volume":"27","author":"Wazni","year":"2025","journal-title":"Europace"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1007\/s12471-025-02005-7","article-title":"Left atrial appendage occlusion vs standard of care in high stroke risk atrial fibrillation patients ineligible for anticoagulation: COMPARE-LAAO","volume":"34","author":"Aarnink","year":"2026","journal-title":"Neth. Heart J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2083","DOI":"10.1056\/NEJMoa2517213","article-title":"Left atrial appendage closure or anticoagulation for atrial fibrillation","volume":"394","author":"Doshi","year":"2026","journal-title":"N. Engl. J. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1056\/NEJMoa2513310","article-title":"Left atrial appendage closure or medical therapy in atrial fibrillation","volume":"394","author":"Landmesser","year":"2026","journal-title":"N. Engl. J. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.ahj.2025.04.015","article-title":"Rationale and design of the anticoagulant therapy after left atrial appendage closure (ATLAAC) trial","volume":"287","author":"Gosvig","year":"2025","journal-title":"Am. Heart J."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Heeger, C.H., Reincke, S., Popescu, S.S., Hatahet, S., Subin, B., Traub, A., Kuck, K.H., Eitel, C., and Tilz, R.R. (2026). Cryoballoon-based left atrial appendage isolation and closure in patients with atrial fibrillation: The LALALAND pilot study. J. Clin. Med., 15.","DOI":"10.3390\/jcm15082980"},{"key":"ref_22","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-Thoracic Surgery (EACTS)","volume":"45","author":"Rienstra","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e034815","DOI":"10.1161\/JAHA.124.034815","article-title":"Left atrial appendage closure compared with oral anticoagulants for patients with atrial fibrillation: A systematic review and network meta-analysis","volume":"13","author":"Oliva","year":"2024","journal-title":"J. Am. Heart Assoc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e1086","DOI":"10.1016\/j.hrthm.2025.07.051","article-title":"Left atrial appendage closure vs oral anticoagulation for stroke prevention in atrial fibrillation: Long-term outcomes from 4 randomized trials","volume":"22","author":"Kaisaier","year":"2025","journal-title":"Heart Rhythm"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Wang, C., Zhu, D., Nan, J., and Zhang, D. (2025). Left atrial appendage closure versus oral anticoagulants in atrial fibrillation: A systematic review and meta-analysis. J. Cardiovasc. Dev. Dis., 12.","DOI":"10.3390\/jcdd12120483"},{"key":"ref_26","first-page":"103037","article-title":"C-47|Left atrial appendage closure versus oral anticoagulation for stroke prevention in atrial fibrillation: A systematic review & meta-analysis of up-to-date evidence","volume":"4","author":"Naeem","year":"2025","journal-title":"J. Soc. Cardiovasc. Angiogr. Interv."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e70217","DOI":"10.1002\/clc.70217","article-title":"Comparing effectiveness and safety of left atrial appendage closure devices: A network meta-analysis of randomized controlled trials","volume":"48","author":"Davis","year":"2025","journal-title":"Clin. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1007\/s00392-025-02697-2","article-title":"Comparison of left atrial appendage occlusion with medical treatment for non-valvular atrial fibrillation: Systematic review, network and reconstructed individual patient data meta-analysis","volume":"115","author":"Lerman","year":"2026","journal-title":"Clin. Res. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Juneja, M., Patel, D., Garde, M., Kandula, A., John, M.E., Patel, P.N., Reddy, G.S., Shekar, V., Khan, R., and Ramteke, H.D. (2025). Comparative efficacy and safety of left atrial appendage occlusion versus direct oral anticoagulants in atrial fibrillation: A systematic review and meta-analysis. medRxiv.","DOI":"10.1101\/2025.09.21.25336272"},{"key":"ref_30","first-page":"101391","article-title":"A real-world multicenter study on left atrial appendage occlusion: The Italian multi-device experience","volume":"51","author":"Procopio","year":"2024","journal-title":"Int. J. Cardiol. Heart Vasc."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e044422","DOI":"10.1161\/JAHA.125.044422","article-title":"Impact of peridevice leak on clinical outcomes after left atrial appendage closure: The OCEAN-LAAC Registry","volume":"14","author":"Saito","year":"2025","journal-title":"J. Am. Heart Assoc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e040404","DOI":"10.1161\/JAHA.124.040404","article-title":"Left atrial appendage closure in patients refusing oral anticoagulation: The LAAC-REFUSAL study","volume":"14","author":"Galea","year":"2025","journal-title":"J. Am. Heart Assoc."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1111\/ejh.70155","article-title":"Oral anticoagulation after atrial fibrillation ablation: An updated systematic review and meta-analysis of 267,443 patients","volume":"116","author":"Matteucci","year":"2026","journal-title":"Eur. J. Haematol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"4288","DOI":"10.57187\/s.4288","article-title":"Safety and effectiveness of left atrial appendage occlusion in patients with atrial fibrillation and high bleeding risk: A cardinality-matched comparison with direct oral anticoagulation on long-term stroke and bleeding rates","volume":"155","author":"Gilhofer","year":"2025","journal-title":"Swiss Med. Wkly."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"ehaf784.3268","DOI":"10.1093\/eurheartj\/ehaf784.3268","article-title":"Impact of left atrial appendage closure on events after severe bleeding in anticoagulated patients with atrial fibrillation: Real life data from the PERSEO registry","volume":"46","author":"Prieto","year":"2025","journal-title":"Eur. Heart J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1428","DOI":"10.1016\/j.jacep.2026.02.023","article-title":"Long-term outcomes of left atrial appendage occlusion vs direct oral anticoagulants in patients with atrial fibrillation and prior ischemic stroke: A propensity-matched analysis","volume":"12","author":"Tabaja","year":"2026","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.ahj.2023.05.022","article-title":"Rationale and design of a randomized study comparing the Watchman FLX device to DOACs in patients with atrial fibrillation","volume":"264","author":"Kar","year":"2023","journal-title":"Am. Heart J."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2368","DOI":"10.1016\/j.jcin.2021.08.060","article-title":"Conformal left atrial appendage seal device for left atrial appendage closure: First clinical use","volume":"14","author":"Sommer","year":"2021","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_39","first-page":"e100284","article-title":"Comparative safety and efficacy of left atrial appendage occlusion technologies for prevention of stroke and bleeding in atrial fibrillation: A comprehensive meta-analysis of Watchman versus oral anticoagulation and alternative device platforms","volume":"17","author":"Opone","year":"2025","journal-title":"Cureus"},{"key":"ref_40","first-page":"291","article-title":"Efficacy and safety of the new generation Watchman FLX device compared to the Watchman 2.5: A systematic review and meta-analysis","volume":"13","author":"Najim","year":"2023","journal-title":"Am. J. Cardiovasc. Dis."},{"key":"ref_41","first-page":"109","article-title":"Watchman FLX versus Amplatzer Amulet for percutaneous left atrial appendage occlusion: A systematic review and meta-analysis","volume":"88","author":"Carvalho","year":"2025","journal-title":"J. Cardiol."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Batko, J., Litwinowicz, R., Kapelak, B., and Bartu\u015b, K. (2024). First-in-human percutaneous epicardial-only left atrial appendage closure using Sierra Left Atrial Appendage Ligation System. J. Clin. Med., 13.","DOI":"10.3390\/jcm13237417"},{"key":"ref_43","first-page":"e93019","article-title":"Direct comparative safety and anatomical performance of Amulet versus Watchman devices for left atrial appendage occlusion","volume":"17","year":"2025","journal-title":"Cureus"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Yasmin, F., Ali, E., Moeed, A., Zaidi, F., Umar, M., and Virwani, V. (2024). Safety and efficacy of percutaneous Watchman 2.5 device versus Amplatzer Amulet for left atrial appendage closure in patients with non-valvular atrial fibrillation: A systematic review and study-level meta-analysis. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0295804"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1161\/CIRCULATIONAHA.118.035090","article-title":"Device-related thrombus after left atrial appendage closure: Incidence, predictors, and outcomes","volume":"138","author":"Dukkipati","year":"2018","journal-title":"Circulation"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1093\/ehjcvp\/pvaf078","article-title":"Antithrombotic strategies and DOAC dosing following left atrial appendage occlusion: A network meta-analysis","volume":"12","author":"Samaras","year":"2026","journal-title":"Eur. Heart J. Cardiovasc. Pharmacother."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1348","DOI":"10.1016\/j.jcmg.2025.07.018","article-title":"Outcomes of left atrial appendage patency after device closure detected by cardiac CT: A meta-analysis","volume":"18","author":"Jacquemyn","year":"2025","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1093\/eurheartj\/ehad828","article-title":"Residual leaks following percutaneous left atrial appendage occlusion and outcomes: A meta-analysis","volume":"45","author":"Samaras","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1765","DOI":"10.1016\/j.jacc.2023.08.010","article-title":"Network meta-analysis of initial antithrombotic regimens after left atrial appendage occlusion","volume":"82","author":"Carvalho","year":"2023","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e030080","DOI":"10.1161\/JAHA.123.030080","article-title":"Pattern of endothelialization in left atrial appendage occluder by optic coherence tomography: A pilot study","volume":"13","author":"Chen","year":"2024","journal-title":"J. Am. Heart Assoc."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Paragliola, V., Chiarazzo, E., Parato, A.G., Marchetta, M., Sasso, S., Sangiorgi, G.M., Natale, A., and Iannaccone, M. (2026). Device-related thrombosis after left atrial appendage occlusion: Updated management and contemporary challenges. Cardiovasc. Med., 29.","DOI":"10.3390\/cardiovascmed29020016"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Balbaa, E., Rakab, M.S., Gadelmawla, A.F., Amin, A.M., Tawfik, A.M., Elgendy, A., Al-Ihribat, A.R., Turkmani, M., Altobaishat, O., and Elgendy, M.S. (2026). The additive value of preprocedural cardiac computed tomography angiography (CCTA) planning in percutaneous left atrial appendage occlusion: A systematic review and meta-analysis. J. Interv. Card. Electrophysiol., Epub ahead of printing.","DOI":"10.1007\/s10840-026-02273-2"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1093\/ehjci\/jeaf078","article-title":"Imaging assessment after percutaneous left atrial appendage closure: From immediate to long-term follow-up","volume":"26","author":"Holmes","year":"2025","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Jabbour, J.P., Palombi, M., Bonanni, M., Matteucci, A., Arcari, L., Pierucci, N., La Fazia, V.M., Lavalle, C., and Mariani, M.V. (2025). The role of cardiac magnetic resonance in characterizing atrial cardiomyopathy and guiding substrate ablation in atrial fibrillation: A narrative review. J. Cardiovasc. Dev. Dis., 12.","DOI":"10.3390\/jcdd12040114"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"e70115","DOI":"10.1002\/joa3.70115","article-title":"Intracardiac echocardiography versus transesophageal echocardiography guidance on left atrial appendage occlusion in patients with atrial fibrillation: A systematic review and meta-analysis","volume":"41","author":"Khan","year":"2025","journal-title":"J. Arrhythm."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1007\/s10554-025-03330-z","article-title":"Intracardiac or transesophageal echocardiography for left atrial appendage occlusion: An updated systematic review and meta-analysis","volume":"41","author":"Beneki","year":"2025","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"102815","DOI":"10.1016\/j.jacadv.2026.102815","article-title":"Intracardiac versus transesophageal echocardiography for left atrial appendage occlusion: A meta-analysis","volume":"5","author":"Yaser","year":"2026","journal-title":"JACC Adv."},{"key":"ref_58","first-page":"103404","article-title":"F-20 | Imaging modalities for left atrial appendage occlusion: Comparing the post-procedural utility of transesophageal echocardiography vs cardiac computerized tomography angiography","volume":"4","author":"Khasnavis","year":"2025","journal-title":"J. Soc. Cardiovasc. Angiogr. Interv."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Kanschik, D., Polzin, A., Heidari, H., Dannenberg, L., Phinicarides, R., Klein, K., Werner, N., Kelm, M., Jung, C., and Afzal, S. (2025). Comparative study of automated real-time left atrial appendage sizing using patient-specific 3D heart models versus transesophageal echocardiography and multidetector computed tomography in patients with nonvalvular atrial fibrillation: Implications for device selection. J. Clin. Med., 14.","DOI":"10.3390\/jcm14165696"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"100753","DOI":"10.1016\/j.shj.2025.100753","article-title":"WATCHMAN complications revisited using ultra-high resolution photon-counting computed tomography","volume":"10","author":"Diamant","year":"2026","journal-title":"Struct. Heart"},{"key":"ref_61","first-page":"1419","article-title":"Catheter based left atrial appendage closure in-hospital outcomes in Germany from 2016 to 2020","volume":"113","author":"Maier","year":"2024","journal-title":"Clin. Res. Cardiol."},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Zhang, S., Cui, Y., Li, J., Tian, H., Yun, Y., Zhou, X., Fang, H., Zhang, H., Zou, C., and Ma, X. (2022). Concomitant transcatheter occlusion versus thoracoscopic surgical clipping for left atrial appendage in patients undergoing ablation for atrial fibrillation: A meta-analysis. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.970847"},{"key":"ref_63","first-page":"e82817","article-title":"Efficacy and safety of combined catheter ablation and left atrial appendage closure in atrial fibrillation: A systematic review and meta-analysis","volume":"17","author":"Rawat","year":"2025","journal-title":"Cureus"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"euaf143","DOI":"10.1093\/europace\/euaf143","article-title":"Comparative outcomes of left atrial appendage occlusion with and without catheter ablation: A 5-year propensity-matched analysis","volume":"27","author":"Motairek","year":"2025","journal-title":"Europace"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"euag017","DOI":"10.1093\/europace\/euag017","article-title":"Feasibility, procedural efficiency, and early imaging outcomes of concomitant pulsed field ablation and left atrial appendage closure: A prospective single-centre study","volume":"28","author":"Doty","year":"2026","journal-title":"Europace"},{"key":"ref_66","unstructured":"Shereef, H., Erickson, L., Fischer, G.J., Kanani, J., and Sra, J. (2026, January 20). Institutional experience of concomitant atrial fibrillation ablation and left atrial appendage occlusion. Proceedings of the 52nd Annual Scientific Day, Milwaukee, WI, USA."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"2742","DOI":"10.1016\/j.jacep.2025.08.014","article-title":"Impact of device compression on peridevice leak after left atrial appendage closure: The IMPRESSION-LAAC study","volume":"11","author":"Galea","year":"2025","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Yao, Y., Jin, Q., Zhang, X., and Lv, Q. (2025). Clinical effectiveness and safety comparison between direct oral anticoagulants and warfarin for nonvalvular atrial fibrillation patients following percutaneous left atrial appendage closure operation intervention: A prospective observational study. BMC Pharmacol. Toxicol., 26.","DOI":"10.1186\/s40360-024-00834-7"},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Imperatore, G., Lochy, S., Ben Yedder, M., Galea, R., and Aminian, A. (2025). Percutaneous left atrial appendage closure: Supporting evidence, limitations and future directions. J. Clin. Med., 14.","DOI":"10.3390\/jcm14072300"},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Nagy, K.V., Arn\u00f3th, B., Koml\u00f3si, F., Gell\u00e9r, L., and Merkely, B. (2025). Overcoming NOAC-resistant left atrial appendage thrombus in atrial fibrillation: Clinical gaps and therapeutic insights. Front. Cardiovasc. Med., 12.","DOI":"10.3389\/fcvm.2025.1664386"},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Zou, Q., Jiang, C., Lin, P., Yu, Y., Li, J., Zhao, F., Hu, H., and Sun, S. (2024). Management of complications associated with percutaneous left atrial appendage closure with or without ablation: Experience from 512 cases over a 4-year period. Front. Cardiovasc. Med., 11.","DOI":"10.3389\/fcvm.2024.1388024"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1038\/s41586-025-10091-1","article-title":"Long-term thrombus-free left atrial appendage occlusion via magnetofluids","volume":"651","author":"Wang","year":"2026","journal-title":"Nature"},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Cipollone, P., Pierucci, N., Matteucci, A., Palombi, M., Laviola, D., Bruti, R., Vinciullo, S., Bernardi, M., Spadafora, L., and Cersosimo, A. (2025). Artificial intelligence in cardiac electrophysiology: A comprehensive review. J. Pers. Med., 15.","DOI":"10.3390\/jpm15110532"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.xjtc.2025.07.012","article-title":"Stroke prevention in nonvalvular atrial fibrillation: Thoracoscopic left atrial appendage closure with or without surgical ablation","volume":"33","author":"Ito","year":"2025","journal-title":"JTCVS Tech."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"102268","DOI":"10.1016\/j.xjtc.2026.102268","article-title":"Endocardial obliterative left atrial appendage closure by inverted purse-string plication","volume":"36","author":"Nakamura","year":"2026","journal-title":"JTCVS Tech."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"e42885","DOI":"10.1097\/MD.0000000000042885","article-title":"Left atrial appendage occlusion procedure and antithrombotics: Less may be enough for lower risk patients: A single-center observational study","volume":"104","author":"Kim","year":"2025","journal-title":"Medicine"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"e46199","DOI":"10.1097\/MD.0000000000046199","article-title":"Peri-device leak and late massive thrombus formation after left atrial appendage occlusion: A case report","volume":"104","author":"Chen","year":"2025","journal-title":"Medicine"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6526\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T12:10:01Z","timestamp":1787573401000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6526"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,24]]},"references-count":77,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15176526"],"URL":"https:\/\/doi.org\/10.3390\/jcm15176526","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,24]]}}}