Year in Review: Left Atrial Appendage Occlusion and Stroke Prevention: An Interview With Jacqueline Saw, MD

In this video from the 2025 SCAI Scientific Sessions, JIC speaks with Dr Jacqueline Saw about her session titled "Year in Review: Left Atrial Appendage Occlusion and Stroke Prevention."

Read the session summary here.

Transcript:

Hi, my name is Dr. Jacqueline Saw from Vancouver General Hospital, clinical professor at UBC.

Over the past year, what do you consider the most significant advancement or shift in clinical practice related to LAAO as it relates to stroke prevention?

There are a few important studies that have been published or presented. I would say the most important one is the OPTION trial, which is a large, 1600-patient, randomized trial comparing WATCHMAN [FLX] to OAC for patients undergoing catheter ablation for AFib. And this trial actually showed non-inferiority in terms of the primary efficacy endpoint and superiority in terms of the primary safety endpoint in terms of reducing bleeding, both non-procedural bleeding as well as ISTH major bleeding and clinically relevant bleeding. As well, both endpoints were superior with the WATCHMAN FLX compared to OAC.

What unanswered questions or gaps would you like to see addressed in the coming years?

I think the key question that most of us have is: how does left atrial appendage closure stack up against DOAC in all-comers, not just patients undergoing ablation, like in OPTION? So, this is being addressed in the CHAMPION-AF trial as well as the CATALYST trial; the CHAMPION is randomizing patients to WATCHMAN FLX vs DOAC, and CATALYST is randomizing patients to the Amulet vs DOAC. Both of these trials are enrolling patients who are eligible for OAC. I think this will be key to show if LAA closure with either of these devices is safe and efficacious compared to standard-of-care DOAC currently.

What current trials are you most looking forward to seeing the results for?

In terms of which trial I'm most excited about that's upcoming, I would say actually both the CHAMPION and the CATALYST, because I think the results from these trials could potentially tip all guidelines to Class 1 for this procedure. Currently, we stand at Class 2A for patients with high thromboembolic risk and with irreversible bleeding as an indication for Class 2A. So, with the data results from these 2 trials, we could shift and improve our clinical recommendations in these guidelines.

The transcript has been lightly edited for clarity.