{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T12:04:41Z","timestamp":1791201881918,"version":"4.2.0"},"reference-count":0,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>The near-simultaneous publication of CHAMPION-AF and CLOSURE-AF produced apparently discordant evidence regarding percutaneous left atrial appendage closure (LAAC) for stroke prevention in atrial fibrillation. We aimed to reconcile these findings through a phenotype-based framework and identify the determinants of net clinical benefit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>This narrative review integrates randomized trials, registries, consensus documents, and guidelines, focusing on patient selection, procedural risk, post-implant antithrombotic therapy, endpoint construction, competing mortality, and time to benefit. CHAMPION-AF evaluated LAAC against direct oral anticoagulation in an elective, anticoagulation-eligible population with lower bleeding risk, demonstrating non-inferior thromboembolic protection and less non-procedural bleeding. Conversely, CLOSURE-AF enrolled an older, multimorbid population with substantial renal dysfunction, previous bleeding, and high competing mortality. Although implantation success and stroke rates were comparable between treatment groups, early procedural and antithrombotic-related bleeding, a composite endpoint incorporating procedural events, and limited survival reduced the opportunity for delayed benefit. The highly selective recruitment pathway further limits generalisability. These findings define a continuum from the \u201cCHAMPION-like\u201d patient, with sufficient physiological reserve and life expectancy to realise long-term benefit, to the \u201cCLOSURE-like\u201d patient, in whom frailty and competing risk may outweigh the advantage of appendage exclusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>LAAC efficacy is not determined by device performance alone but by matching the intervention to patient phenotype and time horizon. Selection should integrate thromboembolic and bleeding risk, frailty, renal function, post-implant treatment tolerance, and expected survival. Future trials require transparent screening data, time-sensitive endpoints, landmark analyses, and competing-risk methods.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/europace\/euag286","type":"journal-article","created":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T11:43:00Z","timestamp":1790941380000},"source":"Crossref","is-referenced-by-count":0,"title":["Percutaneous Left Atrial Appendage Closure: The CHAMPION-like vs CLOSURE-like Patient Phenotype Framework"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5244-0556","authenticated-orcid":false,"given":"Sergio","family":"Berti","sequence":"first","affiliation":[{"name":"Fondazione Toscana Gabriele Monasterio, Ospedale del Cuore \u201cG. Pasquinucci\u201d , Massa ,","place":["Italy"]},{"name":"Interdisciplinary Center for Health Sciences, Scuola Superiore Sant\u2019Anna , Pisa ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8960-7006","authenticated-orcid":false,"given":"Philippe","family":"Garot","sequence":"additional","affiliation":[{"name":"Institut Cardiovasculaire Paris Sud (ICPS), H\u00f4pital Priv\u00e9 Jacques Cartier, Ramsay Sant\u00e9 , Massy ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9165-7732","authenticated-orcid":false,"given":"Giancarlo","family":"Trimarchi","sequence":"additional","affiliation":[{"name":"Fondazione Toscana Gabriele Monasterio, Ospedale del Cuore \u201cG. Pasquinucci\u201d , Massa ,","place":["Italy"]},{"name":"Interdisciplinary Center for Health Sciences, Scuola Superiore Sant\u2019Anna , Pisa ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6473-2900","authenticated-orcid":false,"given":"Jens Erik","family":"Nielsen-Kudsk","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Aarhus University Hospital , Aarhus ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7566-1626","authenticated-orcid":false,"given":"Gregory Y H","family":"Lip","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science, University of Liverpool , Liverpool ,","place":["United Kingdom"]},{"name":"Department of Clinical Medicine, Aalborg University , Aalborg ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4953-601X","authenticated-orcid":false,"given":"Carsten","family":"Skurk","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charit\u00e9, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin , Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2020-8891","authenticated-orcid":false,"given":"Valeria","family":"Caso","sequence":"additional","affiliation":[{"name":"Neurology\u2013Stroke Unit, Saronno Hospital, ASST Valle Olona , Saronno ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4591-4220","authenticated-orcid":false,"given":"Lucas V A","family":"Boersma","sequence":"additional","affiliation":[{"name":"Cardiology Department, St. Antonius Ziekenhuis Nieuwegein , Nieuwegein ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3837-3462","authenticated-orcid":false,"given":"Domenico G","family":"Della Rocca","sequence":"additional","affiliation":[{"name":"Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9820-4815","authenticated-orcid":false,"given":"Giuseppe","family":"Boriani","sequence":"additional","affiliation":[{"name":"Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena , Modena ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2536-2871","authenticated-orcid":false,"given":"Alan John","family":"Camm","sequence":"additional","affiliation":[{"name":"Molecular and Clinical Sciences Research Institute, City St George\u2019s University of London , London ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,5]]},"container-title":["Europace"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/europace\/advance-article-pdf\/doi\/10.1093\/europace\/euag286\/71601467\/euag286.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/europace\/advance-article-pdf\/doi\/10.1093\/europace\/euag286\/71601467\/euag286.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T11:42:07Z","timestamp":1791200527000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/europace\/advance-article\/doi\/10.1093\/europace\/euag286\/8864850"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,5]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1093\/europace\/euag286","relation":{},"ISSN":["1099-5129","1532-2092"],"issn-type":[{"value":"1099-5129","type":"print"},{"value":"1532-2092","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,5]]},"article-number":"euag286"}}