Purpose of Review <p>This review discusses the epidemiology and mechanisms of atrial fibrillation (AF) in cardiac amyloidosis (CA), the limitations of current stroke risk assessment models in this population, the utility of advanced imaging to detect atrial thrombus, the role of oral anticoagulation, and the emerging role of left atrial appendage occlusion.</p> Recent Findings <p>Patients with cardiac amyloidosis are at increased risk of developing atrial fibrillation, and the coexistence of these conditions significantly elevates the risk of thromboembolic events, particularly ischemic stroke. Standard stroke risk stratification tools such as CHA₂DS₂-VASc may underestimate this risk in amyloidosis due to disease-specific factors like atrial mechanical dysfunction, impaired hemodynamics and intracardiac thrombus formation in sinus rhythm.</p> Summary <p>A precision medicine approach is required to mitigate stroke risk in this high-risk population.</p>