I have a Pelagian one on my Pelagian, and I have a Chris Kennedy custom one as well that's going on my SF2 eventually. I've seen the Fathom in person, it's a nice MAV, and I like the recessed O2 add. It's a nice feature. Overall the whole unit is just a Pelagian if it was built in the US instead of some garage in Thailand. The cell-face clearing, the needle valve, the limited electronics are all things that the Pelagian did years ago (not saying Andy invented any of the concepts), and all are very useful features. The larger tube, the removable radial scrubber, the nice head attachment design, and counterlungs that aren't made out of scooter innertubes taken from Chinese knock-offs of Ural motorcycles are all things that Fathom did that make it a much better unit in terms of overall construction. To be perfectly honest I'd rather have a Fathom than a Pelagian. Unblocked of course....
As far as the adds themselves, personally IMO they're all a block of delrin with a spinny thingy and a button that goes psssshhhh. In the case of these three, one has an unprotected button (Pelagian), one has a protected button (Fathom), and one has an unprotected button and a QC on the bottom (Chris Kennedy). All three protect the needle valve by placing it in between the O2 hoses. Andy wants stupid money for the Pelagian ones separately, the only benefit is that it's tiny. The Chris Kennedy ones are super nice, but they're in Australia, and I'd like to see the Fathom ones readily available on the market for a reasonable cost to purchase separately, as I think needle valves are the way to go regardless of the unit you dive. Unless you have a specific need for a tiny MAV or a custom one, the Fathom is the most attractive in my mind.