Safety and Efficacy of Left Atrial Appendage Occlusion in Cardiac Amyloidosis: A Single-Center Retrospective Study.

OBJECTIVE

To evaluate procedural success, safety, and clinical outcomes of left atrial appendage closure (LAAC) in patients with cardiac amyloidosis (CA).

BACKGROUND

CA is a progressive, infiltrative cardiomyopathy associated with an elevated risk of thromboembolic events, particularly in the setting of atrial fibrillation (AF). These patients are often elderly and at higher risk of bleeding. While LAAC offers an alternative to oral anticoagulation (OAC) for stroke prevention in high-bleeding-risk AF patients, data on its safety and efficacy in CA remain limited.

METHODS

We retrospectively analyzed 21 patients with confirmed CA who underwent LAAC between January 2014 and December 2024. Data on demographics, procedural details, post-procedural management, and outcomes were collected. The primary endpoints were procedural success and incidence of post-procedure thromboembolic and bleeding events.

RESULTS

Most patients had wild-type transthyretin amyloidosis (90.5%) and persistent AF (71.4%). Procedural success was achieved in 95% of patients, with no intra- or peri-procedural complications. Over a median follow-up of 24 months, there were no cases of device-related thrombosis or major peri-device leaks. Three patients (14.3%) experienced minor peri-device leak. Two patients (9.5%) had major bleeding, which occurred while on post-procedural OAC. Two patients (9.5%) experienced ischemic stroke or TIA, and both patients were given DOAC as a result (Central illustration).

CONCLUSION

LAAC appears to be a safe and feasible stroke prevention strategy for patients with CA, achieving high procedural success with low complication rates.