Outcomes of Left Atrial Appendage Occlusion in Patients with Hypertrophic Cardiomyopathy, Rheumatic Heart Disease and Cardiac Amyloidosis (JCEP May 2026)-Article: Outcomes of Left Atrial Appendage Occlusion in patients with Hypertrophic Cardiomyopathy, Rheumatic Heart Disease and Cardiac Amyloid

Article: Outcomes of Left Atrial Appendage Occlusion in patients with Hypertrophic Cardiomyopathy, Rheumatic Heart Disease and Cardiac Amyloid

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This retrospective cohort study used OptumLabs claims data to evaluate outcomes after left atrial appendage occlusion (LAAO) in 14,755 adults with nonvalvular atrial fibrillation (AF), comparing patients with AF alone to those with AF plus hypertrophic cardiomyopathy (HCM), rheumatic heart disease (RHD), or cardiac amyloidosis (CA). Median follow-up was 1.4 years.<br /><br />Overall, patients with AF and structural heart disease (SHD: HCM, RHD, or CA combined) had a higher composite event rate than those with AF alone, but there were no significant differences in overall mortality, stroke/TIA, or major gastrointestinal/intracranial bleeding. The main excess risk in the combined SHD group was in “other” bleeding events.<br /><br />When the SHD subgroups were analyzed separately:<br />- HCM: outcomes were similar to AF alone, with no significant differences in mortality, stroke/TIA, or bleeding.<br />- RHD: stroke/TIA and mortality were similar to AF alone, but “other” bleeding was higher.<br />- CA: patients had the worst outcomes, with significantly higher risks of stroke/TIA, gastrointestinal bleeding, and the composite endpoint; mortality was also numerically higher but not statistically significant.<br /><br />Subgroup analyses suggested some differences by age, sex, and race, but the overall pattern remained that HCM showed comparable outcomes to AF alone, while CA and RHD were associated with higher bleeding risk. Falsification analyses were largely negative, supporting that the main findings were not likely due to major confounding.<br /><br />The authors conclude that LAAO appears reasonable in complex AF patients, especially those with HCM or RHD, but patients with CA may represent a sicker, higher-risk population. The results are observational and hypothesis-generating, particularly because HCM and CA sample sizes were small.

Meta Tag

Concept Left Atrial Appendage Occlusion

Concept Non-valvular Atrial Fibrillation

Concept Stroke Prevention

Concept Anticoagulation

Concept Hypertrophic Cardiomyopathy

Keywords

left atrial appendage occlusion

atrial fibrillation

hypertrophic cardiomyopathy

rheumatic heart disease

cardiac amyloidosis

claims data

retrospective cohort study

stroke risk

bleeding outcomes

structural heart disease

Left Atrial Appendage Occlusion

Non-valvular Atrial Fibrillation

Stroke Prevention

Anticoagulation

Hypertrophic Cardiomyopathy