Does catheter-based ablation therapy improve symptoms and reduce arrhythmia recurrence in patients with cardiac amyloidosis and atrial arrhythmias?
Catheter ablation for atrial arrhythmias in patients with cardiac amyloidosis provides symptomatic relief, though underlying disease mortality remains high, particularly in the AL subtype.
BACKGROUND: Cardiac amyloidosis (CA) is associated with increased atrial arrhythmias risk. The efficacy/safety of catheter-based ablation therapy in patients with CA has not been adequately assessed. METHODS AND RESULTS: All diagnosed CA patients who underwent atrial arrhythmia ablation therapy from 1995 to 2015 were reviewed. Arrhythmia recurrence, NYHA symptoms, and mortality were recorded. A total of 26 patients with CA and atrial arrhythmias were included; there were 7 light-chain (AL), 17 wild-type transthyretin (ATTRwt), and 2 mutated transthyretin (ATTRm) amyloidosis patients in total. Of which 13 underwent atrial arrhythmia ablation (CA-A) and 13 underwent AV nodal ablation (CA-AVN). In the CA-A group, there were: 3 with atrial fibrillation (AF); 6 with atrial flutter (AFL); 2 with AF/AFL; and 2 with atrial tachycardia (AT). One-year and 3-year recurrence-free survival were 75% and 60%, respectively. NYHA symptom improvement 6 months postablation was observed in both CA-A and CA-AVN groups: 7/10 (70%) and 4/8 (50%), respectively. Eleven patients with CA died (8 in CA-AVN group vs. 3 in CA-A group). CONCLUSIONS: Catheter-based ablation for patients with CA appears to provide important symptomatic relief. However, mortality from the underlying disease remains a significant issue for the amyloid light-chain subtype.
Tan et al. (Sat,) studied this question.
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