Dr Vivek Reddy and Devi Nair Decode CHAMPION-AF Results at ACC.26

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At ACC.26 in New Orleans, Dr Devi Nair (Arkansas, US) and Dr Vivek Reddy (New York, US) dissect the late-breaking CHAMPION‑AF trial, a large randomized comparison of first-line left atrial appendage closure with WATCHMAN FLX versus continued NOAC therapy in patients with non-valvular AF who can tolerate anticoagulation. They review the trial design, post‑implant antithrombotic and imaging strategy, and dual primary endpoints at 3 years, focusing on how to balance a modest absolute increase in ischaemic stroke/systemic embolism against a substantial reduction in clinically relevant bleeding.

The discussion highlights key controversies: whether a roughly 0.33% per‑year increase in ischaemic events is acceptable for selected patients, how to handle procedure‑related complications in bleeding endpoints, and the true clinical weight of “clinically relevant non‑major” bleeding. The faculty then place CHAMPION‑AF alongside OPTION, OCEAN, ALONE and CLOSURE‑AF, translating this growing evidence base into practical, case-based guidance on when to consider first-line LAA closure versus lifelong NOACs—especially in post‑ablation and intermediate-risk patients—and what clinicians should look for in forthcoming 5‑year data.

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Cardiology
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