6.1 LAA Occlusion: The Best OPTION and how to CHAMPION the Procedural Volume
Problem Presenter: Nick Amoroso
Problem Presenter: Nick Amoroso
These proceedings summarize the educational activity of the 18th Biennial Meeting of the International Andreas Gruentzig Society held January 27 to 30, 2026, in Puerto Ayora, Santa Cruz, Ecuador.
Faculty Disclosures Sponsors
2026 IAGS Summary Document
Statement of problem or issue
The burden of atrial fibrillation (Afib) around the world is enormous, estimated at 50-60 million people. Untreated, these individuals are at risk for thromboembolic events, especially stroke. Oral anticoagulation (OAC) has been a mainstay of treatment in patients with Afib, with or without ablation. Yet there are many individuals who are at high risk for bleeding (HBR). Estimates place the proportion of patients with Afib and HAS-BLED scores ≥3 at approximately 30%, resulting in 15-18 million patients who might need alternatives to OAC. Left atrial appendage occlusion (LAAO) is one alternative to anticoagulation. In the ACC/AHA/ACCP/HRS guidelines, LAAO has a Class 2a recommendation. [1] There have been two recent trials of LAAO versus anticoagulation:
OPTION [2]
- Randomized to LAAO (Watchman) or to OAC, after ablation.
- Similar rates of death/embolism/stroke.
- 44% RRR in bleeding, including procedural.
- Conclusion: LAAO non-inferior to OAC in Afib patients after ablation.
CHAMPION [3]
- Randomized to LAAO (Watchman) or to OAC, any eligible Afib patient.
- Similar rates of death/embolism/stroke.
- 45% RRR in bleeding.
- Net clinical benefit (all events): 15.1% (LAAO) vs 21.8% (OAC), HR = 0.66, P<.001.
- Conclusion: LAAO noninferior to OAC in Afib patients eligible for OAC.
The greater difficulty is that only approximately 9% of eligible patients with Afib receive treatments every year. The worldwide capacity of 150,000-180,000 LAAO yearly implants is woefully inadequate. Although this capacity is growing by 25,000-35,000 slots per year, it is still inadequate. Availability of anesthesiologists and EP procedure room slots are bottlenecks.
Gaps in current knowledge
- Should all LAAO devices be considered equal in treatment paradigm?
- How to manage patients with suboptimal LAAO?
- What are long-term effects of LAAO as early first line therapy versus later second-line therapy?
- How to increase LAAO (and all EP) capacity?
- How to increase referrals to close the unmet needs gap?
- Imaging: when are pre-procedure and/or post-procedure imaging not needed?
Possible solutions or future directions
Longer-term directions:
- Comparative studies of strategies - what is needed to provide both the best Afib control and the best thromboembolic protection for patients.
Shorter-term directions:
- How can we improve access to care with LAAO?
- Support for care referrals-
- Automated referrals from patient records.
- AI-supported patient identification, referral, and capacity analysis.
- AI-agent for automated patient and provider education.
- Legislation/policy changes for widespread economic support (insurance, reimbursement, national health coverage).
- LAAO implant efficiencies-
- Predictive analytics for implant device choice, procedure planning.
- AI-augmented procedure imaging.
- Reduce multiple providers needed (i.e. anesthesia, procedural imager, etc).
- Make follow-up less burdensome-
- Improved techniques to obviate routine f/u imaging.
- Reduce registry burden-
- Re-evaluate frequency of follow-up and necessary end-points.
- Automated data collection.
References
- Joglar J, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation. J Am Coll Cardiol. 2024; 83: 109–279. doi.org/10.1016/j.jacc.2023.08.017.
- Wazni OM, et al; OPTION Trial Investigators. Left Atrial Appendage Closure after Ablation for Atrial Fibrillation. N Engl J Med. 2025 Apr 3;392(13):1277-1287. doi: 10.1056/NEJMoa2408308. Epub 2024 Nov 16. PMID: 39555822.
- Doshi SK, et al; CHAMPION-AF Investigators. Left Atrial Appendage Closure or Anticoagulation for Atrial Fibrillation. N Engl J Med. 2026 Mar 28. doi: 10.1056/NEJMoa2517213. Epub ahead of print. PMID: 41910347.
© 2026 HMP Global. All Rights Reserved.
Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of the Journal of Invasive Cardiology or HMP Global, their employees, and affiliates.
