Future Perspectives for Left Atrial Appendage Closure: CHAMPION-AF and CATALYST Clinical Trials

Left atrial appendage occlusion (LAAO) has currently a class of recommendation IIa for non-valvular AF patients with high thromboembolic risk and contraindication for oral anticoagulation. CHAMPION-AF and CATALYST are two upcoming randomized trials that will be comparing DOAC to LAAO with the WATCHMAN FLX and Amulet, respectively, in patients at standard bleeding risk with non-valvular AF and without contraindication for oral anticoagulation. Taken together, these trials will help to address the role of LAAO in a contemporary setting where DOAC is the current standard anticoagulation treatment for atrial fibrillation. Moreover, these large trials will allow for a better estimate of procedural risk and long-term effects of LAAO given longer follow-up and larger sample size than the initial LAAO trials. This chapter will review the rationale of these important trials and discuss the implications of their possible outcomes.