Catheter ablation for atrial fibrillation in patients with cardiac amyloidosis - Clinical characteristics and outcomes

Background

Atrial fibrillation (AF) is frequent in patients with cardiac amyloidosis and is often poorly tolerated and associated with a high symptom burden. Catheter ablation (CA) for AF in the general population is associated with high success rates and has become standard of care for AF treatment. However, few data are available on its success, feasibility, and safety in patients with cardiac amyloidosis.

Objective

This retrospective study aimed to characterize the clinical and echocardiographic characteristics of patients with cardiac amyloidosis undergoing CA for atrial arrythmias (AAs), to analyze procedural parameters, and describe acute and long-term success.

Methods

Baseline characteristics, comorbidities, echocardiographic parameters, and procedural parameters were collected from a prospectively lead digital ablation database. Ablation outcomes were evaluated up to one-year post-ablation.

Results

Out of 3551 patients receiving CA for AAs between 2018 and 2025, we identified 31 patients (age 77 ± 8 years; male: n=27, 87%) with diagnosed cardiac amyloidosis (ATTR: n=29, 94%; AL: n=2, 6%). At baseline, half of the patients had a preserved left ventricular ejection fraction (n=20, 51%) and left atria were dilated (left atrial volume index 48 ± 18 mL/m²). Conduction abnormalities, defined as any degree AV block or known sick-sinus-syndrome, were present in 15 (48%) patients.

Persistent AF was present in most patients (n=24, 77%). CA was performed using radiofrequency ablation (RFA) (n=19, 61%), pulsed field ablation (PFA) (n=11, 36%), or cryoballoon ablation (n=1, 3%). No major periprocedural complications occurred. Three-month-follow-up data was available in 23 patients (74%) and one-year-follow-up data in 17 of those patients (55%). An AA recurrence was documented in 6 out of 17 (35%) patients who had already received one year follow-up (AF: n=5, 83%; AT n=1, 17%).

Conclusion

Catheter ablation of AAs in patients with cardiac amyloidosis is feasible and safe. Outcomes are comparable to patients without cardiac amyloidosis.