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Arrhythmias & electrophysiologyCohort study

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

JACC Clin ElectrophysiolPublished

  • retrospective cohort
  • multivariable Cox models
  • subgroup analyses
Read the original article ↗

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

Main finding

As reported in the abstract

Composite endpoint:
  • Mortality
  • Stroke/TIA
  • Bleeding

Hazard ratio

1.63

95% CI 1.17–2.27

P = 0.004

AF + CA vs AF
HR 1.63 (95% CI 1.17–2.27); P = 0.004

Observational data: associations, not effects.

Further findings

OutcomeHR (95% CI)P value
Stroke/TIA · higher risk with AF + CA2.00 (1.13–3.54)P = 0.02

Clinical outcomes, AF + HCM vs AF alone

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

Safety

OutcomeHR (95% CI)P value
Nongastrointestinal/intracranial bleeding events · higher risk with AF + RHD1.24 (1.04–1.49)P = 0.02
Gastrointestinal bleeding · higher risk with AF + CA2.50 (1.14–5.47)P = 0.02

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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Summarised from the published abstract; every number is checked against it