January 10, 2026Journal of Interventional Cardiac Electrophysiology0 citations

Comparative outcomes after atrial fibrillation catheter ablation in patients with cardiac amyloidosis: a multicenter propensity-matched analysis

AMAhmed K. MahmoudBoston Medical Center RIRamzi IbrahimWinnMed HPHoang Nhat PhamMayo Clinic

Key Result

Patients with ATTR-CM had a 28% higher rate of composite outcomes after AF ablation compared to non-ATTR-CM patients (37.2% vs. 29.3%, aHR 1.24; p = 0.006).

Key Points

This analysis aims to compare outcomes of atrial fibrillation catheter ablation in patients with and without cardiac amyloidosis.
Identified adults undergoing AF ablation from 2010 to 2024.
Divided patients into ATTR-CM and non-ATTR-CM cohorts using propensity score matching.
Analyzed a primary composite outcome and several secondary outcomes.
Utilized statistical analyses including chi-square, t-tests, Cox regression, and Kaplan-Meier curves.
The ATTR-CM cohort had higher rates of the composite outcome (37.2% vs. 29.3%; p = 0.006).
Significantly more cardioversion was noted in the ATTR-CM group (13.7% vs. 8.3%; p = 0.001).
Higher initiation of antiarrhythmics occurred in the ATTR-CM cohort (30.8% vs. 23.9%; p = 0.012).
Acute heart failure exacerbations were more frequent in ATTR-CM patients (22.5% vs. 15.5%; p = 0.003).
Hospitalization rates were also higher in the ATTR-CM cohort (39.5% vs. 30.7%; p = 0.003).

Structured PICO

Does atrial fibrillation catheter ablation yield worse clinical and arrhythmic outcomes in patients with ATTR-CM compared to matched patients without ATTR-CM?

Population

Adults undergoing atrial fibrillation (AF) catheter ablation from 2010 to 2024, specifically comparing patients with transthyretin amyloid cardiomyopathy (ATTR-CM) to a propensity-matched non-ATTR-CM cohort. Total n=1,924 (962 per cohort), mean age 71, 23% female.

Intervention

Atrial fibrillation catheter ablation in patients with transthyretin amyloid cardiomyopathy (ATTR-CM)

Comparator

Atrial fibrillation catheter ablation in 1:1 propensity-matched patients without ATTR-CM (matched for demographics, comorbidities, labs, and medications)

Outcome

Composite of cardioversion, initiation of class I/III antiarrhythmics, or repeat ablation between 3 and 12 months post-procedurecomposite

Patients with ATTR-CM undergoing AF ablation experience significantly higher rates of recurrent arrhythmias requiring intervention, heart failure exacerbations, and hospitalizations compared to matched non-ATTR-CM patients.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

INTRODUCTION: Atrial fibrillation (AF) is common in patients with transthyretin amyloid cardiomyopathy (ATTR-CM) due to amyloid infiltration and atrial fibrosis, complicating AF management. Although AF ablation has been studied within ATTR-CM populations, comparative outcomes between patients with and without ATTR-CM remain unclear. METHODS: Adults undergoing AF ablation from 2010 to 2024 were identified and divided into ATTR-CM and non- ATTR-CM cohorts. Propensity score matching (1:1) balanced demographics, comorbidities, labs, and medications. The primary composite outcome included cardioversion, initiation of class I/III antiarrhythmics, or repeat ablation between 3 and 12 months post-procedure. Secondary outcomes included individual components, acute heart failure exacerbations (AHF), hospitalizations, and mortality. Statistical analyses involved chi-square, t-tests, Cox regression, and Kaplan-Meier survival curves. RESULTS: After matching, 962 patients per cohort were analyzed (mean age 71, 23% female). The ATTR-CM cohort had higher rates of the composite outcome (37.2% vs. 29.3%, aHR 1.24; p = 0.006), cardioversion (13.7% vs. 8.3%, p = 0.001), antiarrhythmic initiation (30.8% vs. 23.9%, p = 0.012), AHF (22.5% vs. 15.5%, p = 0.003), and hospitalizations (39.5% vs. 30.7%, p = 0.003). CONCLUSION: Careful risk stratification is critical in ATTR-CM patients undergoing AF ablation to optimize management and outcomes.

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