Felipe Hernández

CHAMPION AF is out at ACC - (nejm.org/doi/full/10.10…) and there are gonna be some hurt feelings on both sides! Thanks @TCTMD (tctmd.com/news/chaampion…) for the commentary. My thoughts having read the paper a couple of times: 1. LAAO seems to invoke passions in people – I think this study won’t sway either counter party. If you believe in this approach you will be reassured by no increased risk of stroke, reduction in bleeding and the excellent safety profile of the procedure. If you are an LAAO heretic I think you’ll worry about the low event rate – although the absolute differences in stroke/SE maybe approaching clinical irrelevance (1%over three years, 0.3% a year). The differences either way are so small for a patient/clinician this effect isn't going to factor in my decision making. 2. So who won CHAMPION-AF? – patients. I think this solidifies LAAO as an alternative to DOAC. Patients can now meet with their cardiologist and discuss the trade-offs of each strategy. If patients are procedurally oriented they may be willing to accept a potential very small increased risk of stroke/SE to get off medications. Conversely, patients taking DOAC can be reassured that their risk of major bleeds/ICH are comparable to having a device – although they are much more likely to have bleeding events that need medical attention. Both strategies are acceptable and those discussions will really center around patient preference. 3. How does this fit in existing literature? Procedures are not drugs – and device type and procedural hygiene matter. Making sure we minimize complications from both the procedure and post-procedure care are paramount. This continues to improve with device iterations and studies optimizing post-implant medical regimens. CHAMPION proves this is an incredibly safe procedure in the right hands. 4. What comes next? – this sets the stage for important 5 year data. The primary outcome of that is ischemic stroke and systemic embolization. In theory ischemic risk and bleeding risk could continue to diverge. CATALYST will also be set to present – with a similar design but unfortunately an older generation device. LAAOS4 - adding DOAC to Watchman is a compelling hypothesis and we are recruiting! Either way - LAAO is now mainstream and with all therapies patient preference is going to rule the day.

🫀 Conociendo a nuestros miembros @pipecardio, patrono de Fundación EPIC y cardiólogo intervencionista en el Hospital Universitario Quirón La Luz. #FundaciónEPIC #CardiologíaIntervencionista #Investigación #SaludCardiovascular