Outcomes of Left Atrial Appendage Occlusion in Patients With Hypertrophic Cardiomyopathy, Rheumatic Heart Disease, and Cardiac Amyloidosis

Alabdaljabar, MS; Al-Abcha, A; Alkhouli, M; Hibbert, B; Liu, XK; Simard, T; Van Houten, H; Yao, X; Del-Carpio Munoz, F; Melduni, RM; Noseworthy, PA; Rushlow, DR; Friedman, P; Killu, AM

doi:10.1016/j.jacep.2025.12.019

Arrhythmias & electrophysiology

Outcomes of Left Atrial Appendage Occlusion in Patients With Hypertrophic Cardiomyopathy, Rheumatic Heart Disease, and Cardiac Amyloidosis

JACC Clin ElectrophysiolPublished 22 Jan 2026retrospective cohort

Main finding · Composite endpoint (mortality, stroke/TIA, bleeding)ResultHazard ratio 1.63 95% CI 1.17–2.27

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Authors' conclusion

Patients with AF and either RHD or CA experienced higher bleeding rates following LAAO compared with 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 patients with AF and HCM vs those without. Because of the small sample size, the results in HCM and CA cohorts are mainly hypothesis generating.

Study context

Population: Adult patients with nonvalvular atrial fibrillation (NVAF) undergoing left atrial appendage occlusion (LAAO) (2015–2023), OptumLabs Data Warehouse, with and without comorbid hypertrophic cardiomyopathy (HCM), rheumatic heart disease (RHD), or cardiac amyloidosis (CA)patients included (mean age 76.5 ± 7.0, 43.7% female, median follow-up 1.4 [0.8–2.4] years)
Participants: 14,755 patients

Exposure: LAAO in patients with NVAF, with and without comorbid HCM, RHD, or CA
Outcome: Composite endpoint:
Mortality
Stroke/TIA
Bleeding

Methodological detailsmultivariable Cox models, subgroup analyses

Multivariable Cox models
Subgroup analyses

Main finding

As reported in the abstract

Hazard ratio

1.63

95% CI 1.17–2.27

P = 0.004

AF + CAvs AF

HR 1.63 (95% CI 1.17–2.27); P = 0.004

Observational data: associations, not effects.

Further findings

Outcome	← Lower risk with AF + CA ←→ Higher risk with AF + CA →	HR (95% CI)	P value
Stroke/TIAAF + CAvs AFHigher risk with AF + CA	0.20.5125	2.00 (1.13–3.54)	P = 0.02
	0.20.5125Hazard ratio (log scale)

Clinical outcomes, AF + HCM vs AF alone

No significant differences in clinical outcomes between patients with AF alone and those with AF + HCM

Safety

Outcome	← Lower risk vs AF ←→ Higher risk vs AF →	HR (95% CI)	P value
Nongastrointestinal/intracranial bleeding eventsAF + RHDvs AFHigher risk with AF + RHD	0.20.5125	1.24 (1.04–1.49)	P = 0.02
Gastrointestinal bleedingAF + CAvs AFHigher risk with AF + CA	0.20.5125	2.50 (1.14–5.47)	P = 0.02
	0.20.5125Hazard ratio (log scale)

Original publication

Outcomes of Left Atrial Appendage Occlusion in Patients With Hypertrophic Cardiomyopathy, Rheumatic Heart Disease, and Cardiac Amyloidosis. JACC Clin Electrophysiol. Published 22 January 2026. doi:10.1016/j.jacep.2025.12.019

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