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

BACKGROUND

Left atrial appendage occlusion (LAAO) has emerged as an effective stroke- prevention strategy for selected patients with nonvalvular atrial fibrillation (NVAF). However, LAAO outcomes data in patients with hypertrophic cardiomyopathy (HCM), rheumatic heart disease (RHD), or cardiac amyloidosis (CA), are limited.

OBJECTIVES

This study aimed to compare the safety and efficacy of LAAO in patients with NVAF, with and without comorbid HCM, RHD, or CA.

METHODS

Using OptumLabs Data Warehouse, a retrospective cohort of adult patients undergoing LAAO (2015-2023) was analyzed. Outcomes included mortality, stroke/transient ischemic attack (TIA), and bleeding, with multivariable Cox models and subgroup analyses.

RESULTS

A total of 14,755 patients (mean age 76.5 ± 7.0, 43.7% female, median follow-up 1.4 [0.8-2.4] years) were included. Compared with patients with AF, patients AF + RHD had high risk of nongastrointestinal/intracranial bleeding events (HR: 1.24; 95% CI: 1.04-1.49; P = 0.02), whereas AF + CA showed higher risk of composite endpoint (mortality, stroke/TIA, bleeding) (HR: 1.63; 95% CI: 1.17-2.27; P = 0.004), stroke/TIA (HR: 2.00; 95% CI; 1.13-3.54; P = 0.02), and gastrointestinal bleeding (HR: 2.50; 95% CI: 1.14-5.47; P = 0.02). There were no significant differences in clinical outcomes between patients with AF alone and those with AF + HCM.

CONCLUSIONS

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.