In this expert discussion, Dr Karim Al-Azizi (Baylor Scott & White The Heart Hospital, US), Editor-in-Chief of the Transcatheter Academy, is joined by steering committee members Dr Devi Nair (Chief VP of Research, Arkansas Heart Hospital, US) and Dr Megan Coylewright (Essentia Health, US) to unpack the landmark CHAMPION-AF trial (NCT05964200) and its implications for stroke prevention in atrial fibrillation.

Drawing on this large, prospective, multicentre randomised trial of over 3,000 anticoagulation-eligible patients, the panel describe how Watchman FLX left atrial appendage closure demonstrated non-inferiority versus continued direct oral anticoagulation (DOAC) therapy for the primary efficacy endpoint of stroke, systemic embolism and cardiovascular/unexplained death at 3 years. They highlight the significant safety advantage, with superior reductions in non-procedural major bleeding events after the initial post-procedure period, reflecting the sustained benefit of discontinuing long-term anticoagulation.

Rather than positioning appendage closure as a wholesale replacement for DOACs, the experts advocate a patient-centred paradigm shift. They explore how CHAMPION AF elevates device therapy from a rescue option to a legitimate alternative in appropriately selected patients—particularly younger individuals, those with lifestyle constraints or cumulative bleeding concerns—while underscoring the critical role of shared decision-making, rhythm control strategies and long-term monitoring.

The discussion also addresses key evidence gaps and future directions, including integration with evolving AF ablation outcomes (e.g. OPTION, OCEAN-AF trials), refined patient selection via atrial myopathy assessment, next-generation device iterations and the need for extended 5-year data to guide guideline evolution.

Taken together, this nuanced analysis positions CHAMPION-AF as a pivotal step toward precision stroke prevention in AF: broadening access to non-pharmacological options while emphasising individualised care over one-size-fits-all anticoagulation.

Recorded remotely, 2026.
Support: This is an independent educational video produced by Transcatheter Academy.
Editor: Mirjam Boros
Videographer: Mike Knight