Key result
LAAO shows comparable mortality and stroke rates in cardiac amyloidosis versus non-amyloidosis patients.
Why the study?
Patients with cardiac amyloidosis and AF have elevated thromboembolic and bleeding risks that complicate long-term anticoagulation. Although percutaneous left atrial appendage occlusion is an established alternative, patients with cardiac amyloidosis were underrepresented in major trials and outcome data remained limited.
Does percutaneous left atrial appendage occlusion result in comparable rates of all-cause mortality and ischemic stroke in patients with cardiac amyloidosis and atrial fibrillation compared to non-cardiac amyloidosis patients?
Meta-Analysis (n=67,302)
Does percutaneous left atrial appendage occlusion result in comparable rates of all-cause mortality and ischemic stroke in patients with cardiac amyloidosis and atrial fibrillation compared to non-cardiac amyloidosis patients?
This first meta-analysis of observational data suggests that percutaneous LAAO in patients with cardiac amyloidosis and AF is feasible with comparable mortality, stroke, and bleeding outcomes to non-CA patients, supporting its consideration in carefully selected patients unsuitable for long-term anticoagulation.
May support LAAO consideration in cardiac amyloidosis; extends observational data but leaves open randomized confirmation.
Background/introduction Patients with cardiac amyloidosis (CA) frequently develop atrial fibrillation (AF) due to atrial infiltration and remodeling. both conditions increase thromboembolic risk, while amyloid-related vascular fragility and anticoagulation increase bleeding risk, complicating long-term therapy. Left atrial appendage occlusion (LAAO) is an established alternative to anticoagulation in selected AF populations; however, patients with CA were underrepresented in major trials, and outcome data remain limited. We present the first meta-analysis of outcomes of LAAO for AF in CA patients. Purpose To systematically evaluate the safety and efficacy of LAAO in patients with CA and AF compared with non-CA patients undergoing LAAO. Methods Pubmed, embase, cochrane databases, and clinicaltrials.gov were searched from january 2000 to january 2026 for studies reporting outcomes of LAAO in adult patients with CA and AF with a non-CA comparator. Studies with ≥180 days follow-up were included. Primary outcomes were all-cause mortality and ischemic stroke; secondary outcomes were major bleeding and hospitalization. Pooled analyses were performed using the inverse variance method within a random-effects model to calculate incidence rate ratios (IRR) with 95% confidence intervals (CI). IRR was used as it accounts for differences in follow-up duration across different studies. The Hartung-Knapp-Sidik-Jonkman adjustment was applied to account for the small number of included studies. Sensitivity analyses included subgroup analysis and leave-one-out sensitivity analysis to assess robustness. Results Four observational studies comprising 67,302 patients (852 CA and 66,450 non-CA) met inclusion criteria. compared with non-CA patients, CA patients undergoing LAAO had no statistically significant difference in all-cause mortality (IRR 1.65, 95% CI 0.62–4.39), ischemic stroke (IRR 2.15, 95% CI 0.82–5.65), major bleeding (IRR 1.14, 95% CI 0.42–3.13), or hospitalization (IRR 0.91, 95% CI 0.65–1.28). Confidence intervals were wide and crossed unity. Sensitivity analyses showed pooled estimates were influenced by large datasets, with heterogeneity for selected outcomes indicating limited robustness and highlighting the hypothesis-generating nature of these findings. Conclusion In pooled observational data, LAAO in patients with CA and AF appears feasible, with outcomes comparable to non-CA populations despite elevated baseline risk. These findings support consideration of LAAO in carefully selected CA patients unsuitable for long-term anticoagulation. Prospective multicenter studies with standardized antithrombotic strategies and amyloid subtype–specific analyses (AL vs ATTR) are needed to better define patient selection and long-term efficacy.
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Almakadma et al. (2026) conducted a meta-analysis in Atrial fibrillation with or without cardiac amyloidosis undergoing left atrial appendage occlusion (n=67,302). Cardiac amyloidosis in patients undergoing percutaneous left atrial appendage occlusion vs. Non-cardiac amyloidosis patients undergoing left atrial appendage occlusion was evaluated on All-cause mortality and ischemic stroke (IRR 1.65 (all-cause mortality); IRR 2.15 (ischemic stroke), 95% CI 0.62-4.39 (all-cause mortality); 0.82-5.65 (ischemic stroke)). Left atrial appendage occlusion in cardiac amyloidosis vs non-CA patients showed no significant difference in mortality (IRR 1.65; 95% CI 0.62-4.39) or stroke (IRR 2.15; 95% CI 0.82-5.65).
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