Alexa Knierim and Brandon Frazier became the first American pair to win a world figure skating title since 1979.
Knierim and Frazier posted the highest scores in the short program and free skate (221.09) to win by 21.54 points over Japanese pair Riku Miura and Ryuichi Kihara (199.55).
Canadian duo Vanessa James and Eric Radford had to settle for bronze (197.32).
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But it was not all good news for American skaters as Ashley Cain-Gribble fell twice in her routine with partner Timothy LeDuc, meaning the pair had to withdraw.
Cain-Gribble and LeDuc, who were in second after the short program, were bidding to give USA their first one-two in any world's event since 1997.
However, it went badly wrong as Cain-Gribble fell while trying to produce a triple loop and a triple Salchow. She then had to be helped off the ice.
USA had not won a pairs medal since 2002 until Thursday and were helped that the top five teams from the Olympics made up of Russia and China were not competing at the figure skating world championships.
Great Britain duo Zoe Jones and Christopher Boyadji, in their last competitive skate, finished in tenth.
Jones, 42, said afterwards: "This is my partner's decision. Christopher wants to develop as a coach. We train kids together at the Swindon skating rink, he also has his own elite skating school and another business that he is trying to build from scratch. Plus, Christopher has applied to become a technician.
"At 42, I would still ride, to be honest. But we are a couple, and I don’t have the right to keep a person if he is tired of the sport."
MIXED PAIRS FINAL STANDINGS
1. Alexa Knierim/Brandon Frazier (USA) — 221.09
2. Riku Miura/Ryuichi Kihara (JPN) — 199.55
3. Vanessa James/Eric Radford (CAN) — 197.32
4. Karina Safina/Luka Berulava (GEO) — 191.74
5. Minerva Fabienne Hase/Nolan Seegert (GER) — 189.61
6. Evelyn Walsh/Trennt Michaud (CAN) — 176.03
7. Miriam Ziegler/Severin Kiefer (AUT) — 166.68
8. Camille Kovalev/Pavel Kovalev (FRA) — 153.73
9. Daria Danilova/Michel Tsiba (NED) — 148.55
10. Zoe Jones/Christopher Boyadji (GBR) — 144.24
WD. Ashley Cain-Gribble/Timothy LeDuc (USA)
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