Left Atrial Appendage Closure Offers Alternative to Anticoagulation for Some with Atrial Fibrillation

CHAMPION-AF trial finds device-based closure noninferior to oral anticoagulants for ischemic outcomes, with lower bleeding risk.

Mar. 28, 2026 at 3:49pm

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In a randomized trial of patients with atrial fibrillation, those assigned to left atrial appendage closure had similar ischemic outcomes but significantly lower rates of bleeding compared to those assigned oral anticoagulation. The CHAMPION-AF study found the device-based closure approach was noninferior to anticoagulants for the composite endpoint of cardiovascular death, stroke, and systemic embolism at 3 years.

Why it matters

The findings suggest left atrial appendage closure could be a reasonable alternative treatment option for some patients with atrial fibrillation who are deemed suitable for long-term anticoagulation but may be at higher risk of bleeding complications. This could provide an important new approach for managing stroke risk in this patient population.

The details

The CHAMPION-AF trial randomly assigned 3,000 patients with atrial fibrillation to receive either the Watchman FLX left atrial appendage closure device or a non-vitamin K antagonist oral anticoagulant. At 3 years, the device group had a 5.7% rate of the primary efficacy endpoint (a composite of cardiovascular death, stroke, or systemic embolism), compared to 4.8% in the anticoagulation group, meeting the criteria for noninferiority. However, the device group had a significantly lower rate of nonprocedural bleeding at 10.9% versus 19% in the anticoagulation group.

  • The CHAMPION-AF trial was presented at the American College of Cardiology Scientific Session and published in The New England Journal of Medicine in March 2026.

The players

Saibal Kar

MD, FACC, FSCAI, program director of the cardiovascular disease fellowship at Los Robles Regional Medical Center in Thousand Oaks, California, and national physician director of interventional cardiology at HCA Healthcare USA.

Watchman FLX

A left atrial appendage closure device manufactured by Boston Scientific.

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What they’re saying

“The CHAMPION-AF trial was [conducted] to determine if left atrial appendage closure with the Watchman FLX device is a reasonable alternative compared to non-vitamin K antagonist oral anticoagulants in patients with nonvalvular atrial fibrillation.”

— Saibal Kar, MD, FACC, FSCAI

“Among patients with atrial fibrillation deemed suitable for anticoagulation, device-based left atrial appendage closure using the Watchman FLX device was noninferior for the composite endpoint of stroke, systemic embolism and cardiovascular death compared to [non-vitamin K antagonist oral anticoagulant] therapy.”

— Saibal Kar, MD, FACC, FSCAI

What’s next

Researchers will continue to evaluate additional endpoints comparing the differences in bleeding and thromboembolic events between the two treatment strategies at 5 years.

The takeaway

The CHAMPION-AF trial suggests left atrial appendage closure with the Watchman FLX device could be a reasonable alternative to long-term anticoagulation for some patients with atrial fibrillation, providing similar ischemic protection but with a significantly lower risk of bleeding complications.