Cardiac amyloidosis and left atrial appendage closure. The CAMYLAAC study

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Electrophysiology

Background:

• Transthyretin cardiac amyloidosis (ATTR-CA) frequently coexists with atrial fibrillation, posing risks for stroke and bleeding.
• Patients with ATTR-CA often have higher comorbidity burdens and thromboembolic risk scores.

Purpose of the Study:

• To compare the long-term outcomes of left atrial appendage closure (LAAC) in patients with ATTR-CA versus those without a known CA diagnosis.
• To assess the safety and efficacy of LAAC in a high-risk population.

Main Methods:

• A retrospective comparison of patients who underwent LAAC between 2009 and 2020.
• Stratification of patients into two groups: diagnosed with ATTR-CA and without a known CA diagnosis.
• Long-term follow-up to evaluate complications, stroke, bleeding, and mortality.

Main Results:

• Successful LAAC was achieved in 98.1% of patients, with no significant differences between the ATTR-CA and control groups.
• No significant differences were observed in in-hospital or follow-up ischemic stroke, hemorrhagic stroke, or bleeding events between the groups.
• While 2-year mortality showed no significant difference, 5-year mortality was significantly higher in ATTR-CA patients, independent of hemorrhagic or ischemic events.

Conclusions:

• LAAC is a safe procedure in ATTR-CA patients, effectively reducing bleeding and ischemic stroke risks without increasing early or mid-term complications.
• Despite impaired long-term survival in ATTR-CA patients, LAAC outcomes at 2-year follow-up were comparable to controls, suggesting its potential benefit.