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Outcomes of Left Atrial Appendage Occlusion in Patients With Hypertrophic Cardiomyopathy, Rheumatic Heart Disease,

Mohamad S Alabdaljabar1, Abdullah Al-Abcha1, Mohamad Alkhouli1

  • 1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.

JACC. Clinical Electrophysiology
|January 23, 2026
PubMed

Insights

Left atrial appendage occlusion (LAAO) is effective for stroke prevention in nonvalvular atrial fibrillation (NVAF). Patients with NVAF and either rheumatic heart disease (RHD) or cardiac amyloidosis (CA) face higher bleeding risks post-LAAO, while hypertrophic cardiomyopathy (HCM) shows no significant outcome difference.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Electrophysiology

Background:

  • Left atrial appendage occlusion (LAAO) is a key stroke prevention strategy for nonvalvular atrial fibrillation (NVAF).
  • Limited data exist on LAAO outcomes in patients with comorbid hypertrophic cardiomyopathy (HCM), rheumatic heart disease (RHD), or cardiac amyloidosis (CA).

Purpose of the Study:

  • To compare the safety and efficacy of LAAO in patients with NVAF, stratified by the presence or absence of comorbid HCM, RHD, or CA.

Main Methods:

  • Retrospective analysis of adult patients undergoing LAAO from 2015-2023 using the OptumLabs Data Warehouse.
  • Outcomes assessed included mortality, stroke/transient ischemic attack (TIA), and bleeding events.
  • Multivariable Cox models and subgroup analyses were employed to evaluate risks.

Main Results:

  • Among 14,755 patients, those with NVAF and RHD showed increased non-gastrointestinal/intracranial bleeding (HR: 1.24).
  • Patients with NVAF and CA exhibited higher risks for the composite endpoint (HR: 1.63), stroke/TIA (HR: 2.00), and gastrointestinal bleeding (HR: 2.50).
  • No significant differences in clinical outcomes were observed between patients with NVAF alone and those with NVAF and HCM.

Conclusions:

  • Patients with NVAF and RHD or CA experienced elevated bleeding rates post-LAAO, suggesting a higher inherent bleeding risk.
  • The study supports a potential role for LAAO in these complex patient groups, particularly given similar stroke/TIA rates.
  • Outcomes for patients with NVAF and HCM did not differ significantly from those without HCM, but findings for HCM and CA require further investigation due to sample size limitations.
Abstract

Keywords:
atrial fibrillationcardiac amyloidosishypertrophic cardiomyopathyleft atrial appendage occlusionrheumatic heart disease

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