To investigate the safety and efficacy of transcatheter left atrial appendage occlusion (LAAO) in patients with concomitant atrial fibrillation (AF) and cerebral amyloid angiopathy (CAA) and high bleeding risk that precludes long-term oral anticoagulation.

Consecutive patients with non-valvular AF and a CHA2DS2-VASc score ≥ 2 and concomitant CAA who underwent transcatheter LAAO between 2014 and 2022 at Parma University Hospital were included in the analysis. The primary endpoint was a composite of any ischemic/hemorrhagic events. The observed rates of ischemic and bleeding events were compared with those expected from the CHA2DS2-VASc score and HAS-BLED score.

Twenty-four patients with probable CAA (median age 74.0 years; 66.7% males) qualified for inclusion. During follow up (median time 17 months), 2 ischemic strokes and 2 ICHs occurred. The rate of primary endpoint event was 8.34/100 patients-year compared to an expected rate of 13.80/100 patients-year, resulting in a 39.6% risk reduction. The risk reduction for systemic thromboembolism and major bleeding was respectively 55.2% and 7.3%.

Transcatheter LAAO might be an effective strategy for thromboembolic prevention in patients with AF and concomitant CAA. Because of the potential shortcomings, this study can only be considered as hypothesis-generating.