LAAO in 2026: Translating New Evidence into Practice-LAAO in 2026: Translating New Evidence into Practice

Video Transcription

Video Summary

This session reviewed major 2026 updates in left atrial appendage occlusion (LAAO), with a focus on evidence, program building, procedural efficiency, and real-world decision-making.<br /><br />Michael Rinaldi introduced the panel and framed LAAO as one of the best-studied device spaces in interventional cardiology. Saibal Carr then discussed the CHAMPION-AF trial, which randomized about 3,000 patients with nonvalvular atrial fibrillation and no contraindication to anticoagulation to either NOACs or Watchman FLX LAA closure. At 3 years, LAAO was noninferior for the composite of stroke, cardiovascular death, and systemic embolism, and it significantly reduced clinically relevant nonprocedural bleeding. He emphasized that LAAO may now be considered an alternative to NOACs in selected patients and may expand further in concomitant procedures.<br /><br />Thomas Wagner focused on building scalable LAAO programs. He highlighted the rapid growth of Watchman use across the U.S., major underuse among eligible patients, and the need to identify candidates through EP clinics, structural heart clinics, valve clinics, neurology, and other referral pathways. He argued that concomitant procedures, especially with AF ablation and structural interventions, will increasingly drive future growth.<br /><br />Megan Coilwright emphasized procedural excellence, shared decision-making, and the importance of interventional cardiologists leading these programs. She reviewed data showing very low event rates with modern devices and discussed intracardiac echo, CT planning, and workflow standardization.<br /><br />Finally, Vijay Iyer used case-based discussions to show how these data apply in practice, especially in younger high-risk patients and frail elderly patients. The panel agreed that patient preference, stroke risk, bleeding risk, and life expectancy should guide therapy, and that LAAO has a growing role in contemporary AF management.

Asset Subtitle

Michael J. Rinaldi, MD, FSCAI; Saibal Kar, MD, FSCAI; Thomas E. Waggoner, DO, FSCAI; Megan Coylewright, MD, MPH, FSCAI; Vijay S. Iyer, MD, PhD, FSCAI

Asset Caption

closed captions are computer-generated

Keywords

left atrial appendage occlusion

LAAO

Watchman FLX

atrial fibrillation

CHAMPION-AF trial

noninferiority

NOACs

procedural bleeding

shared decision-making

structural heart