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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Cardiac amyloidosis and left atrial appendage closure. The CAMYLAAC study

Ignacio J Amat-Santos1, José R Delgado-Arana2, Ignacio Cruz-González3

  • 1Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.

Revista Espanola De Cardiologia (English Ed.)
|August 7, 2022
PubMed

Insights

Left atrial appendage closure (LAAC) in transthyretin cardiac amyloidosis (ATTR-CA) patients showed similar early complication rates to controls. While long-term survival was worse for ATTR-CA patients, LAAC may still be a viable option.

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.
Abstract

Keywords:
Amiloidosis cardiacaBleedingCardiac amyloidosisCierre de orejuela izquierdaHeart failureHemorragiasIctusInsuficiencia cardiacaLeft atrial appendage closureStroke

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