Sep 30, 2026 · 13 min · 7 segments
In this discussion, Lorenz Räber and David Seiffge review the latest evidence on percutaneous left atrial appendage (LAA) closure for stroke prevention, focusing on the CLOSURE AF and CHAMPION AF…
Lorenz RäberHostDavid SeiffgeGuestAs a neurologist, I was asking myself from a technical point of view, how can you comment on the technical success of LAA closure in those trials? Is this comparable to your clinical practice or what are your takeaways?
That's a good question because obviously it's a preventive measure and if you send to us a patient that should undergo percutaneous LAA occlusion, you must be sure that we do a good job.
And I think there was a huge evolution in terms of safety over the last decade, an evolution that made out of an experimental treatment really a very, very safe procedure.
If you look at the periprocedure safety data, We note a 1.1% safety endpoint at seven days, which is mainly driven by 0.6% pericardial tamponade and only in 1,500 patients, only one periprocedural stroke.
I think this really makes proof that this has become a very safe procedure as far as the watchman implant is concerned.
So in the champion there was a 1.1% safety endpoint and in the closure AF actually this was up to 6% and it was mainly driven by periprocedural breathing occurring in the first seven days.
And there I think the key learning is that the patients included were probably a bit too old, too polymorbid.
And the second conclusion is that probably it's not a good idea to keep patients who are at high bleeding risk under dual antiplatelet therapy.
Rather, we should aim for a low dose treatment regimen or a single antiplatelet treatment regimen.
so to conclude a bit the safety is clearly there there was a big evolution of the therapy in that regard and based on the two trials i think patients with high bleeding risk they are ideal candidates and patients who do not prefer to take doac are good candidates but we did not discuss in this session is of course combined procedures with combining a PBI with LA occlusion, concomitant procedures.
As a neurologist, I was asking myself from a technical point of view, how can you comment on the technical success of LAA closure in those trials? Is this comparable to your clinical practice or what are your takeaways?
That's a good question because obviously it's a preventive measure and if you send to us a patient that should undergo percutaneous LAA occlusion, you must be sure that we do a good job.
And I think there was a huge evolution in terms of safety over the last decade, an evolution that made out of an experimental treatment really a very, very safe procedure.
If you look at the periprocedure safety data, We note a 1.1% safety endpoint at seven days, which is mainly driven by 0.6% pericardial tamponade and only in 1,500 patients, only one periprocedural stroke.
I think this really makes proof that this has become a very safe procedure as far as the watchman implant is concerned.
So in the champion there was a 1.1% safety endpoint and in the closure AF actually this was up to 6% and it was mainly driven by periprocedural breathing occurring in the first seven days.
And there I think the key learning is that the patients included were probably a bit too old, too polymorbid.
And the second conclusion is that probably it's not a good idea to keep patients who are at high bleeding risk under dual antiplatelet therapy.
Rather, we should aim for a low dose treatment regimen or a single antiplatelet treatment regimen.
so to conclude a bit the safety is clearly there there was a big evolution of the therapy in that regard and based on the two trials i think patients with high bleeding risk they are ideal candidates and patients who do not prefer to take doac are good candidates but we did not discuss in this session is of course combined procedures with combining a PBI with LA occlusion, concomitant procedures.
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