Objective To investigate the safety and efficacy of percutaneous left atrial appendage closure(LAAC)in the prevention of stroke in elderly patients with non-valvular atrial fibrillation(NVAF)complicated with heart failure(HF).Methods A total of 125 NVAF patients aged ≥65 years undergoing percutaneous LAAC in Northern Jiangsu People's Hospital from January 2019 to October 2022 were recruited,and were divided into HF group(35 patients)and non-HF(90 patients)according to whether being complicated with HF.Their clinical features,characteristics of left atrial appendage,operation procedure and follow-up results were analyzed and compared between the two groups.Results The non-HF group had significant smaller proportions of smok-ing,drinking and previous stroke,lower left ventricular ejection fraction(LVEF),and higher ratio of one-stop surgery,but lower renal dysfunction ratio and B-type natriuretic peptide(BNP)lever when compared with the HF group(P＜0.05,P＜0.01).There were no statistical differences in the type of occluder,shape and depth of LAA and long diameter of LAA opening,residual shunt,pericardial effusion,incidence of newly stroke onset and death ratio between the two groups dur-ing perioperative period(P＞0.05).The HF group had an obviously shorter follow-up time(12.10±1.30 months vs 12.72±1.10 months,P=0.025)and higher incidence of recurrent HF(8.57％vs 0％,P=0.005)than the non-HF group.Conclusion LAAO is safe and feasible for elderly NVAF patients complicated with HF,and it is safe and effective in preventing ischemic stroke.