Abstract 18136: Efficacy and Safety of Catheter Ablation for Atrial Arrhythmias in Patients With Cardiac Amyloidosis - A Systematic Review and Proportional Meta-Analysis

Background Cardiac amyloidosis (CA) is a restrictive cardiomyopathy characterised by amylin deposits in the heart muscle. While the prevalence of atrial arrhythmias in CA is high, the data regarding the outcomes of catheter ablation in these patients is limited. Our current study aims to elucidate the safety & efficacy of catheter ablation for treating atrial arrhythmias in patients with CA.

Methods: We conducted a comprehensive literature search across MEDLINE & Scopus from inception till May 2023 for randomized control trials & observational studies reporting catheter ablation (cryoablation or radiofrequency ablation) for the treatment of atrial arrhythmias (AAs) (atrial flutter, atrial fibrillation, atrial tachycardia) in patients with cardiac amyloidosis (transthyretin or light-chain). The primary outcomes of interest were pooled recurrence & re-ablation rates. The secondary outcome was all-cause mortality. All data was analyzed using the Hedges-Olkin random-effects model & presented as percentage proportions.

Results: A total of 6 cohort studies with 154 cardiac amyloidosis patients with atrial fibrillation were included. The pooled incidence of repeat ablation was 16.4% [(6.2%, 26.7%), p=0.002)] & recurrence rate was 47.9% [(25.2%, 70.5%), p<0.001)]. The pooled incidence of all-cause mortality in these patients was 37.1% [(25.1%, 49.1%), p<0.001)].

Conclusion High rate of recurrence & need for re-ablation coupled with high mortality demands better patient selection. Prospective & randomized controlled data is needed to better study the outcomes of catheter ablation in these patients.