Outcomes of patients with cancer undergoing left atrial appendage closure: a systematic review and meta-analysis

Background Patients with cancer and atrial fibrillation (AF) face a challenging trade-off between thromboembolic and bleeding that may limit long-term oral anticoagulation (OAC) maintenance. Left atrial appendage closure (LAAC) represents a potential valid alternative in this group; however, comparative outcomes remain sparse. Objectives To compare outcomes after LAAC in patients with cancer versus those without cancer. Methods We interrogated three electronic databases from inception through December 22, 2025, for studies reporting outcomes in AF patients undergoing LAAC according to cancer status. Outcomes were pooled using random-effects models with restricted maximum likelihood variance estimation. Prespecified time points were in-hospital, 30 days, and 1 year. The primary endpoint was in-hospital all-cause mortality. Results Nine observational studies (193,721 patients, 2,500 with cancer) were included. In-hospital mortality was higher in cancer patients (RR 2.12, 95% CI 1.26-3.56), remaining elevated also at 1-year (RR 1.69, 95% CI 1.15–2.49; I²=18.8%). In-hospital stroke and systemic embolism were also higher in cancer patients (RR 1.62, 95% CI 1.09-2.40; I²=0% and RR 2.01, 95% CI 1.09-3.70; I²=0%), with risk attenuation by 30 days. In-hospital bleeding did not differ significantly (RR 2.70, 95% CI 0.93-7.90); however, this occurred in the context of high heterogeneity (I²=92.4%). Conclusions Cancer patients with AF undergoing LAAC experience worse short- and mid-term outcomes compared to non-cancer patients. Prospective studies with standardized endpoint definitions and cancer-specific stratification are needed to define the net clinical benefit of this strategy in this subset of patients.