{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T13:02:26Z","timestamp":1789650146805,"version":"4.0.0"},"reference-count":76,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"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: For years, the left atrial appendage (LAA) was considered a simple recess of the atrial wall, but recently it has gained its own respectability in the cardiovascular field, therefore its accurate assessment cannot be overlooked in clinical practice. Percutaneous or surgical closure of the LAA has become a valid and safe alternative to reduce the risk of stroke in patients with non-valvular atrial fibrillation (AF), who have long-term contraindications to anticoagulant therapy. Results: This progression was feasible thanks to the developments and the improvements of devices, surgical and imaging techniques. Objectives: This review explores the essential role of multimodality imaging in LAA, including new imaging tools, and its impact on the optimization of closure techniques and outcomes. Conclusions: Multimodality imaging is mandatory for each step along the therapeutic path: patient selection, pre-procedural planning, procedural monitoring, and follow-up.<\/jats:p>","DOI":"10.3390\/jcm15187230","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T11:41:35Z","timestamp":1789645295000},"page":"7230","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Left Atrial Appendage: Mere Spectator or Protagonist? A Narrative Review of Its Multimodal Imaging Assessment and Its Closure Techniques"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3648-9277","authenticated-orcid":false,"given":"Martina","family":"Belli","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Cardiovascular Sciences, European Hospital, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianpiero","family":"Italiano","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Cardiovascular Sciences, European Hospital, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Lassandro Pepe","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Cardiovascular Sciences, European Hospital, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2021-9261","authenticated-orcid":false,"given":"Francesca","family":"Vespasiano","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, Aurelia Hospital, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1837-5997","authenticated-orcid":false,"given":"Roberto","family":"Celotto","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, Aurelia Hospital, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaele","family":"Scaffa","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, European Hospital, Unicamillus University, 00131 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Salica","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, European Hospital, Unicamillus University, 00131 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8928-645X","authenticated-orcid":false,"given":"Paolo","family":"Ciancarella","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Cardiovascular Sciences, European Hospital, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanya","family":"Salvatore","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Cardiovascular Sciences, European Hospital, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donatella","family":"Cantisani","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Cardiovascular Sciences, European Hospital, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiziana","family":"Salatino","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Cardiovascular Sciences, European Hospital, 00149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruggero","family":"De Paulis","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, European Hospital, Unicamillus University, 00131 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2196-2941","authenticated-orcid":false,"given":"Fabrizio","family":"Tomai","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Cardiovascular Sciences, European Hospital, 00149 Rome, Italy"},{"name":"Department of Cardiovascular Sciences, Aurelia Hospital, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3112","DOI":"10.1161\/01.CIR.96.9.3112","article-title":"Anatomy of the normal left atrial appendage: A quantitative study of age-related changes in 500 autopsy hearts: Implications for echocardiographic examination","volume":"96","author":"Veinot","year":"1997","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1843","DOI":"10.1016\/j.hrthm.2013.09.065","article-title":"Relationship between left atrial appendage morphology and stroke in patients with atrial fibrillation","volume":"10","author":"Khurram","year":"2013","journal-title":"Heart Rhythm"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/j.jacc.2012.04.032","article-title":"Does the left atrial appendage morphology correlate with the risk of stroke in patients with atrial fibrillation? Results from a multicenter study","volume":"60","author":"Santangeli","year":"2012","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1016\/j.jcmg.2014.08.009","article-title":"The Left Atrial Appendage: Anatomy, Function, and Noninvasive Evaluation","volume":"7","author":"Beigel","year":"2014","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1007\/s10741-023-10298-2","article-title":"Assessment of left atrial appendage function by echocardiography","volume":"28","author":"Ito","year":"2023","journal-title":"Heart Fail. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1016\/j.jcmg.2015.02.002","article-title":"Percutaneous interventions for left atrial appendage exclusion: Options, assessment, and imaging using 2D and 3D echocardiography","volume":"8","author":"Wunderlich","year":"2015","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1016\/j.jcin.2014.05.026","article-title":"Percutaneous left atrial appendage closure: Procedural techniques and outcomes","volume":"7","author":"Saw","year":"2014","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1016\/j.jcmg.2017.12.019","article-title":"Roles of transesophageal echocardiography and cardiac computed tomography for evaluation of left atrial thrombus and associated pathology: A review and critical analysis","volume":"11","author":"Pathan","year":"2018","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1056\/NEJM199303183281102","article-title":"Cardioversion from atrial fibrillation without prolonged anticoagulation with use of transesophageal echocardiography to exclude the presence of atrial thrombi","volume":"328","author":"Manning","year":"1993","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e209","DOI":"10.1093\/ehjci\/jead096","article-title":"Multimodality imaging for patient selection, procedural guidance, and follow-up of transcatheter interventions for structural heart disease: A consensus document of the EACVI task force on interventional cardiovascular imaging: Part 1: Access routes, transcatheter aortic valve implantation, and transcatheter mitral valve interventions","volume":"24","author":"Agricola","year":"2023","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2465","DOI":"10.1016\/j.jcin.2016.10.035","article-title":"Transseptal techniques for emerging structural heart interventions","volume":"9","author":"Alkhouli","year":"2016","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.jcmg.2019.06.032","article-title":"Imaging for patient\u2019s selection and guidance of LAA and ASD percutaneous and surgical closure","volume":"14","author":"Faletra","year":"2021","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1002\/clc.23869","article-title":"Comparison of multiple imaging modalities for measuring orifice diameter and selecting occluder size in patients undergoing left atrial appendage closure","volume":"45","author":"Zhang","year":"2022","journal-title":"Clin. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1016\/j.echo.2023.05.013","article-title":"Accuracy and reliability of left atrial appendage morphology assessment by three-dimensional transesophageal echocardiographic glass rendering modality: A comparative study with computed tomography","volume":"36","author":"Fiore","year":"2023","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Sun, A., Ren, S., Xiao, Y., Chen, Y., Wang, N., Li, C., Tan, X., Pan, Y., Sun, F., and Ren, W. (2022). Real-time 3D echocardiographic transilluminated imaging combined with artificially intelligent left atrial appendage measurement for atrial fibrillation interventional procedures. Front. Physiol., 13.","DOI":"10.3389\/fphys.2022.1043551"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1016\/j.jcin.2018.05.008","article-title":"Intracardiac versus transesophageal echocardiographic guidance for left atrial appendage occlusion: The LAAO Italian Multicenter Registry","volume":"11","author":"Berti","year":"2018","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2587","DOI":"10.1016\/j.jacep.2023.08.004","article-title":"Intracardiac vs. transesophageal echocardiography for left atrial appendage occlusion with watchman FLX in the U.S","volume":"9","author":"Ferro","year":"2023","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1038\/s41586-023-05881-4","article-title":"Foundation models for generalist medical artificial intelligence","volume":"616","author":"Moor","year":"2023","journal-title":"Nature"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.jcin.2019.08.054","article-title":"Expert Recommendations on Cardiac Computed Tomography for Planning Transcatheter Left Atrial Appendage Occlusion","volume":"13","author":"Korsholm","year":"2020","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1148\/rg.2021200136","article-title":"Pre- and Postprocedural CT of Transcatheter Left Atrial Appendage Closure Devices","volume":"41","author":"Rajiah","year":"2021","journal-title":"Radiographics"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e000627","DOI":"10.1136\/openhrt-2017-000627","article-title":"A comparative study of different imaging modalities for successful percutaneous left atrial appendage closure","volume":"4","author":"Chow","year":"2017","journal-title":"Open Heart"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1093\/ehjci\/jew212","article-title":"CT sizing for left atrial appendage closure is associated with favourable outcomes for procedural safety","volume":"18","author":"Rajwani","year":"2017","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2329","DOI":"10.1016\/j.jcin.2016.07.038","article-title":"Application of 3-Dimensional Computed Tomographic Image Guidance to WATCHMAN Implantation and Impact on Early Operator Learning Curve: Single-Center Experience","volume":"9","author":"Wang","year":"2016","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1161\/CIRCIMAGING.112.000153","article-title":"Detection of left atrial appendage thrombus by cardiac computed tomography in patients with atrial fibrillation: A meta-analysis","volume":"6","author":"Romero","year":"2013","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1038\/nrcardio.2014.77","article-title":"Cardiac imaging for assessment of left atrial appendage stasis and thrombosis","volume":"11","author":"Romero","year":"2014","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1016\/j.jcct.2020.12.003","article-title":"CT assessment of the left atrial appendage post-transcatheter occlusion\u2014A systematic review and meta analysis","volume":"15","author":"Banga","year":"2021","journal-title":"J. Cardiovasc. Comput. Tomogr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2649","DOI":"10.1111\/jce.15720","article-title":"Novel cardiac magnetic resonance imaging-based sizing for left atrial appendage closure","volume":"33","author":"Dallan","year":"2022","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2651","DOI":"10.1111\/jce.15721","article-title":"Cardiac magnetic resonance imaging is a promising modality for left atrial appendage occlusion planning","volume":"33","author":"Ward","year":"2022","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"4635","DOI":"10.1093\/eurheartj\/ehaf194","article-title":"2025 ESC\/EACTS Guidelines for the management of valvular heart disease: Developed by the task force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"46","author":"Praz","year":"2025","journal-title":"Eur. Heart J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1016\/0003-4975(95)00887-X","article-title":"Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation","volume":"61","author":"Blackshear","year":"1996","journal-title":"Ann. Thorac. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1093\/ejcts\/ezt204","article-title":"Safe, effective and durable epicardial left atrial appendage clip occlusion in patients with atrial fibrillation undergoing cardiac surgery: First long-term results from a prospective device trial","volume":"45","author":"Emmert","year":"2014","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_32","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_33","first-page":"134","article-title":"Left atrial appendage occlusion by invagination and double suture technique","volume":"41","author":"Bastarrika","year":"2012","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.xjtc.2024.05.007","article-title":"Efficacy of four different left atrial appendage closure techniques during cardiac surgery-A transesophageal echocardiography follow-up study","volume":"26","author":"Petersen","year":"2024","journal-title":"JTCVS Tech."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Radakovic, D., Penov, K., Lazarus, M., Madrahimov, N., Hamoud, K., Schimmer, C., Leyh, R.G., and Bening, C. (2023). The completeness of the left atrial appendage amputation during routine cardiac surgery. BMC Cardiovasc. Disord., 23.","DOI":"10.1186\/s12872-023-03330-8"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"184","DOI":"10.31083\/j.rcm2406184","article-title":"Different techniques of surgical left atrial appendage closure and their efficacy: A systematic review","volume":"24","author":"Romiti","year":"2023","journal-title":"Rev. Cardiovasc. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1016\/j.jacc.2008.03.067","article-title":"Success of surgical left atrial appendage closure: Assessment by transesophageal echocardiography","volume":"52","author":"Kanderian","year":"2008","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1016\/S0735-1097(00)00765-8","article-title":"Surgical left atrial appendage ligation is frequently incomplete: A transesophageal echocardiograhic study","volume":"36","author":"Katz","year":"2000","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1016\/j.hrthm.2015.03.028","article-title":"Association between incomplete surgical ligation of left atrial appendage and stroke and systemic embolization","volume":"12","author":"Aryana","year":"2015","journal-title":"Heart Rhythm"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1007\/s10840-019-00683-z","article-title":"Ultrasound guidance for femoral venous access in electrophysiology procedures-systematic review and meta-analysis","volume":"59","author":"Pap","year":"2020","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e1435","DOI":"10.4244\/EIJ-D-21-00555","article-title":"Computed tomography-based selection of transseptal puncture site for percutaneous left atrial appendage closure","volume":"17","author":"Fukutomi","year":"2022","journal-title":"EuroIntervention"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1016\/j.jacep.2024.10.024","article-title":"State of the Art in Left Atrial Appendage Occlusion","volume":"11","author":"Garg","year":"2025","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1887","DOI":"10.1161\/01.CIR.0000015698.54752.6D","article-title":"Percutaneous left atrial appendage transcatheter occlusion to prevent stroke in high-risk patients with atrial fibrillation: Early clinical experience","volume":"105","author":"Sievert","year":"2002","journal-title":"Circulation"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1988","DOI":"10.1001\/jama.2014.15192","article-title":"PROTECT AF Steering Committee and Investigators. Percutaneous left atrial appendage closure vs. warfarin for atrial fibrillation: A randomized clinical trial","volume":"312","author":"Reddy","year":"2014","journal-title":"JAMA"},{"key":"ref_45","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_46","doi-asserted-by":"crossref","first-page":"e1038","DOI":"10.4244\/EIJ-D-22-00627","article-title":"Left atrial appendage occlusion","volume":"18","author":"Holmes","year":"2023","journal-title":"EuroIntervention"},{"key":"ref_47","first-page":"1543","article-title":"Amplatzer Amulet Left Atrial Appendage Occluder Versus Watchman Device for Stroke Prophylaxis (Amulet IDE): A Randomized","volume":"144","author":"Lakkireddy","year":"2021","journal-title":"Control. Trial. Circ."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.jacc.2012.06.046","article-title":"Percutaneous left atrial appendage suture ligation using the LARIAT device in patients with atrial fibrillation: Initial clinical experience","volume":"62","author":"Bartus","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/j.jacc.2016.10.010","article-title":"Post-Approval U.S. Experience with Left Atrial Appendage Closure for Stroke Prevention in Atrial Fibrillation","volume":"69","author":"Reddy","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2382","DOI":"10.1111\/jce.16053","article-title":"Adverse events associated with amplatzer left atrial appendage occlusion delivery system: A Food and Drug Administration MAUDE database study","volume":"34","author":"Kewcharoen","year":"2023","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1016\/j.jcin.2022.12.006","article-title":"Peridevice Leak After Left Atrial Appendage Occlusion: Incidence, Mechanisms, Clinical Impact, and Management","volume":"16","author":"Alkhouli","year":"2023","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1754","DOI":"10.1161\/CIRCULATIONAHA.120.050117","article-title":"Primary Outcome Evaluation of a Next-Generation Left Atrial Appendage Closure Device: Results From the PINNACLE FLX Trial","volume":"143","author":"Kar","year":"2021","journal-title":"Circulation"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2188","DOI":"10.1016\/j.jcin.2017.06.072","article-title":"Percutaneous Left Atrial Appendage Closure With the LAmbre Device for Stroke Prevention in Atrial Fibrillation: A Prospective, Multicenter Clinical Study","volume":"10","author":"Huang","year":"2017","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"e013750","DOI":"10.1161\/CIRCINTERVENTIONS.123.013750","article-title":"Outcomes with the WATCHMAN FLX in Everyday Clinical Practice From the NCDR Left Atrial Appendage Occlusion Registry","volume":"17","author":"Kapadia","year":"2024","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_55","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_56","doi-asserted-by":"crossref","first-page":"857","DOI":"10.7326\/0003-4819-146-12-200706190-00007","article-title":"Meta-analysis: Antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation","volume":"146","author":"Hart","year":"2007","journal-title":"Ann. Intern. Med."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1016\/S0140-6736(13)62343-0","article-title":"Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: A meta-analysis of randomised trials","volume":"383","author":"Ruff","year":"2014","journal-title":"Lancet"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1007\/s10072-023-07026-x","article-title":"Do stroke services still show sex differences? A multicenter study","volume":"45","author":"Nahas","year":"2024","journal-title":"Neurol. Sci."},{"key":"ref_59","first-page":"190","article-title":"Sex Differences in Disease Profiles, Management, and Outcomes Among People with Atrial Fibrillation After Ischemic Stroke: Aggregated and Individual Participant Data Meta-Analyses","volume":"1","author":"Wang","year":"2020","journal-title":"Womens Health Rep."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1002\/clc.23257","article-title":"Risk of ischemic stroke and utility of CHA2 DS2 -VASc score in women and men with atrial fibrillation","volume":"42","author":"Tomasdottir","year":"2019","journal-title":"Clin. Cardiol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"e005657","DOI":"10.1161\/JAHA.117.005657","article-title":"Thromboembolic Risk, Bleeding Outcomes and Effect of Different Antithrombotic Strategies in Very Elderly Patients with Atrial Fibrillation: A Sub-Analysis from the PREFER in AF (Prevention of Thromboembolic Events\u2014European Registry in Atrial Fibrillation)","volume":"6","author":"Patti","year":"2017","journal-title":"J. Am. Heart Assoc."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1253\/circrep.CR-24-0061","article-title":"Patient Outcomes in Very Elderly Patients with Non-Valvular Atrial Fibrillation\u2014ANAFIE Registry","volume":"6","author":"Suzuki","year":"2024","journal-title":"Circ. Rep."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1159\/000015809","article-title":"Predictive clinical factors of in-hospital mortality in 231 consecutive patients with cardioembolic cerebral infarction","volume":"8","author":"Arboix","year":"1998","journal-title":"Cerebrovasc. Dis."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1002\/ana.25700","article-title":"Ischemic Stroke despite Oral Anticoagulant Therapy in Patients with Atrial Fibrillation","volume":"87","author":"Seiffge","year":"2020","journal-title":"Ann. Neurol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1111\/pace.14713","article-title":"Cardiac magnetic resonance imaging for left atrial appendage closure planning","volume":"46","author":"Bhuta","year":"2023","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1016\/j.ahj.2004.09.054","article-title":"Left Atrial Appendage Occlusion Study (LAAOS): Results of a randomized controlled pilot study of left atrial appendage occlusion during coronary bypass surgery in patients at risk for stroke","volume":"150","author":"Healey","year":"2005","journal-title":"Am. Heart J."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1177\/15569845241273660","article-title":"The 10 Commandments for Transesophageal Assessment Following Epicardial Surgical Ligation of the Left Atrial Appendage","volume":"19","author":"Mansoor","year":"2024","journal-title":"Innovations"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.carrev.2025.03.021","article-title":"Left atrial appendage occlusion optimized with artificial intelligence-guided CT pre-planning and intra-procedural intracardiac echocardiographic guidance","volume":"80","author":"Kumar","year":"2025","journal-title":"Cardiovasc. Revasc. Med."},{"key":"ref_69","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_70","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_71","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_72","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_73","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1161\/CIRCULATIONAHA.123.067312","article-title":"Concomitant Left Atrial Appendage Occlusion and Transcatheter Aortic Valve Replacement Among Patients with Atrial Fibrillation","volume":"149","author":"Kapadia","year":"2024","journal-title":"Circulation"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1093\/europace\/euz212","article-title":"The left atrial appendage in humans: Structure, physiology, and pathogenesis","volume":"22","author":"Karim","year":"2020","journal-title":"Europace"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.jacc.2017.10.092","article-title":"Left Atrial Appendage Closure and Systemic Homeostasis: The LAA HOMEOSTASIS Study","volume":"71","author":"Lakkireddy","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"e937586","DOI":"10.12659\/MSM.937586","article-title":"Effects of Left Atrial Appendage Closure on Neuroendocrine Function in Patients with Nonvalvular Atrial Fibrillation","volume":"28","author":"Wang","year":"2022","journal-title":"Med. Sci. Monit."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/7230\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T12:09:33Z","timestamp":1789646973000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/7230"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,17]]},"references-count":76,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15187230"],"URL":"https:\/\/doi.org\/10.3390\/jcm15187230","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,17]]}}}