ACC.26 – Late-breaker host Harriette Van Spall (McMaster University, Hamilton, CA) is joined by Saibal Kar, MD (Los Robles Regional Medical Center, US) to discuss CHAMPION‑AF (NCT04394546), a global randomized trial comparing the WATCHMAN FLX left atrial appendage closure device with non–vitamin K oral anticoagulants in patients with non‑valvular atrial fibrillation at elevated stroke risk.

CHAMPION‑AF enrolls adults with non‑valvular AF and CHA₂DS₂‑VASc scores ≥2 in men and ≥3 in women who are suitable for both device implantation and guideline‑directed NOAC therapy, randomizing them to percutaneous LAA closure or continued NOAC treatment. The trial evaluates non‑inferiority of WATCHMAN FLX versus NOACs for a composite of stroke, cardiovascular death, and systemic embolism, and tests for superiority in reducing major and clinically relevant non‑major bleeding over up to 5 years of follow‑up.  

Their conversation examines how CHAMPION‑AF could reshape routine AF care: which patients may benefit most from a one‑time device strategy instead of lifelong anticoagulation, how to individualize decisions based on bleeding risk, comorbidities, and patient preferences, and how forthcoming data might influence guideline recommendations and shared decision‑making around LAA closure.  

Editor: Mirjam Boros  
Video Specialist: Tom Green

Support: This is an independent discussion produced by Radcliffe Cardiology.