Background: Left atrial appendage occlusion (LAAO) has emerged as an effective stroke prevention strategy for selected patients with non-valvular atrial fibrillation (NVAF). However, LAAO outcomes data in patients with hypertrophic cardiomyopathy (HCM), rheumatic heart disease (RHD), or cardiac amyloidosis (CA), are limited.
Objective: To compare the safety and efficacy of LAAO in patients with NVAF, with and without comorbid HCM, RHD, or CA.
Methods: Using OptumLabs Data Warehouse, a retrospective cohort of adult patients undergoing LAAO (2015-2023) was analyzed. Outcomes included mortality, stroke/ transient ischemic attack (TIA), and bleeding, with multivariable Cox models and subgroup analyses.
Results: A total of 14,755 patients (mean age 76.5+7.0, 43.7% female, median follow up 1.4 [0.8-2.4] years) were included. Compared with AF patients, AF+RHD patients had high risk of non-gastrointestinal/intracranial bleeding events (HR=1.24, 95% CI=1.04-1.49, p=0.02), while AF+CA showed higher risk of composite endpoint (mortality, stroke/TIA, bleeding) (HR=1.63, 95% CI=1.17-2.27, p=0.004), stroke/TIA (HR=2.00, 95% CI=1.13-3.54, p=0.02), and gastrointestinal bleeding (HR=2.50, 95% CI=1.14-5.47, p=0.02). There were no significant differences in clinical outcomes between patients with AF alone and those with AF+HCM.
Conclusion: Patients with AF and either RHD or CA experienced higher bleeding rates following LAAO compared to those without these conditions, despite similar stroke/TIA rates in AF+RHD, suggesting a higher inherent bleeding risk, and possibly further supporting a role of LAAO. Importantly, there was no difference in outcomes between AF patients with HCM versus those without. Due to the small sample size, the results in HCM and CA cohorts are mainly hypothesis-generating.
Editor-in-Chief
Kalyanam Shivkumar, MD, PhD, FACC
CME Editor
Kenneth A. Ellenbogen, MD, FACC
Authors
Ammar Killu MBBS
Mohamad S. Alabdalijabar, MBBS
Pau Friedman, MD
Important Dates
Date of Release: May 26, 2026
Term of Approval/Date of CME/MOC Expiration: May 25, 2027