Left atrial appendage closure is entering a new phase.

In this MurmurMD discussion, Dr. Thomas Waggoner speaks with Dr. Jeremiah Depta about how LAA closure is evolving in the era of pulse field ablation, concomitant ablation + LAAO, CHAMPION AF, OPTION, structural heart clinics, and changing program economics.

The conversation centers on a practical question facing interventional cardiologists, electrophysiologists, and health systems:

Who owns the appendage now, and how should programs grow without losing focus on patient outcomes?

Dr. Depta and Dr. Waggoner discuss whether LAA closure should remain a structural heart procedure, shift toward EP-led concomitant workflows, or develop into a broader heart-team model where patient identification matters more than specialty ownership.

KEY TOPICS

• Growth of LAA closure and persistent under-penetration

• EP vs structural heart roles in appendage closure

• Concomitant ablation + LAAO after PFA and OPTION

• CHAMPION AF and possible future indication expansion

• Standalone LAAO vs concomitant procedural strategy

• Capacity, lab block time, reimbursement, and throughput

• Same-day discharge and workflow considerations

• Why valve clinics may be an underused LAAO funnel

• Screening AFib patients in TAVR, mitral, and tricuspid clinics

• Using existing valve CT imaging for LAAO planning

• Shared decision-making and patient counseling

• Coordinator-driven clinic scaling and program growth

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CHAPTERS

00:00 – Introduction: LAA closure in a changing landscape

01:07 – The shift: standalone, concomitant, and program growth

02:43 – PFA, OPTION, CHAMPION AF, and growth projections

05:16 – Who owns the appendage now?

08:23 – Does specialty change who gets identified?

12:06 – EP, PFA, and concomitant strategy

13:43 – Throughput: combined cases vs capacity limits

18:24 – EP block time and downstream program costs

23:20 – Standalone LAAO is not just leftover volume

28:33 – CHAMPION AF and the future playing field

34:31 – Broader indications and patient identification

38:22 – Shared decision-making and heart-team questions

41:52 – Why the valve clinic may be the hidden LAAO funnel

48:44 – Using valve CTs for appendage planning

52:31 – Screening workflows in valve clinic

58:08 – Scaling clinic capacity with coordinators

1:00:39 – Final takeaway: identification matters most

#LAAO #LeftAtrialAppendageClosure #Watchman

#StructuralHeart #Electrophysiology #AFib

#PulseFieldAblation #CHAMPIONAF #OPTIONTrial

#ValveClinic #HeartTeam #MurmurMD