Key result
Cardiac amyloidosis during LAAO linked to ~90% higher risk of major bleeding.
Why the study?
Outcomes after left atrial appendage occlusion in patients with atrial fibrillation and cardiac amyloidosis remain poorly defined.
Does left atrial appendage occlusion yield different outcomes in adults with atrial fibrillation and cardiac amyloidosis compared to those without cardiac amyloidosis?
Cohort (n=1,064)
Yes
Does left atrial appendage occlusion yield different outcomes in adults with atrial fibrillation and cardiac amyloidosis compared to those without cardiac amyloidosis?
Hazard Ratio: 1.9
In patients with atrial fibrillation undergoing left atrial appendage occlusion, the presence of cardiac amyloidosis is associated with similar ischemic and mortality outcomes but a significantly higher risk of major bleeding.
Calls for caution with anticoagulation in cardiac amyloidosis; leaves open net clinical benefit and requires dedicated randomized trials.
Background: Cardiac amyloidosis (CA) is frequently complicated by atrial fibrillation (AF), yet outcomes after left atrial appendage occlusion (LAAO) in this population remain poorly defined. Methods: We conducted a retrospective TriNetX study of adults with AF undergoing LAAO, comparing patients with and without CA after 1:1 propensity matching. Outcomes were assessed using Kaplan-Meier analyses and Cox regression. Results: Among 532 matched pairs, mortality and major adverse cardiovascular events were similar between groups, whereas major bleeding was higher in CA (HR 1.90). Conclusions: LAAO yields comparable ischemic outcomes in CA, though bleeding risk is increased.
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Almakadma et al. (2026) conducted a cohort in Atrial fibrillation and cardiac amyloidosis (n=1,064). Cardiac amyloidosis vs. Without cardiac amyloidosis was evaluated on Mortality, major adverse cardiovascular events, and major bleeding (HR 1.90). Cardiac amyloidosis in adults with atrial fibrillation undergoing left atrial appendage occlusion was associated with similar ischemic outcomes but a higher risk of major bleeding (HR 1.90).
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