What is the clinical evidence from this study?

Study design: Cohort. Population: Non-valvular atrial fibrillation (n=578). Intervention: Atrial amyloidosis (atrial biopsy-detected) vs. Absence of atrial amyloidosis (non-CA). Primary outcome: Composite of all-cause mortality, stroke, and hospitalization for heart failure (adjusted hazard ratio 2.71, 95% CI 1.10-6.70).

What does this research mean for the field?

Atrial biopsy during atrial fibrillation ablation identifies amyloid deposits in 7% of patients, revealing early-stage cardiac amyloidosis that is often confined to the atrium. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To determine the prevalence of cardiac amyloidosis in patients with non-valvular atrial fibrillation and evaluate whether atrial biopsy during ablation can detect early-stage disease.

May 19, 2026European Heart JournalOpen Access

Atrial amyloidosis identified by biopsy in atrial fibrillation: prevalence and clinical presentation

Q: What are the key findings of this study?

Atrial amyloidosis was found in 7% of AF ablation patients and independently increased the risk of death, stroke, and heart failure hospitalization (adjusted HR 2.71).

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Key result

Atrial amyloidosis in AF ablation linked to ~2.7-fold higher risk of major cardiovascular events.

adjusted hazard ratio 2.71
95% CI 1.10-6.70
n=578

Why the study?

This study aimed to assess the prevalence of cardiac amyloidosis in non-valvular AF and test whether early-stage cardiac amyloidosis can be identified via atrial biopsy.

Does the presence of atrial amyloidosis increase the risk of adverse cardiovascular outcomes in patients undergoing atrial fibrillation ablation?

Key Points

To determine the prevalence of cardiac amyloidosis in patients with non-valvular atrial fibrillation and evaluate whether atrial biopsy during ablation can detect early-stage disease.
Performed atrial biopsies in 578 patients undergoing catheter ablation for non-valvular atrial fibrillation, with concomitant right ventricular biopsies performed in 385 patients.
Classified patients into atrial biopsy-detected cardiac amyloidosis, non-cardiac amyloidosis, and a comparator cohort of 58 clinically diagnosed cardiac amyloidosis cases, using immunohistochemistry for amyloid typing.
Amyloid deposits were detected in atrial samples from 40 of 578 patients (7%, 95% CI: 5%–9%), including 25 cases of amyloid transthyretin, with prevalence rising to 20%–40% in patients with older age, left ventricular hypertrophy, and low-voltage areas.
Right ventricular biopsy identified amyloid deposits in 13 of 385 patients (3%, 95% CI: 2%–6%); of 26 patients with atrial amyloidosis who underwent right ventricular biopsy, 13 had deposits confined exclusively to the atrium.
The atrial biopsy-detected group had thicker left ventricular posterior walls (11.3 ± 2.2 vs 9.6 ± 1.4 mm, P < .001) and more frequent low-voltage areas <0.5 mV (45% vs 13%, P < .001) than the non-amyloidosis group, but thinner posterior walls than the clinical amyloidosis group (11.3 ± 2.2 vs 15.3 ± 4.6 mm, P < .001).

Study Design

Type

Cohort (n=578)

Multicenter

Yes

Structured PICO

Does the presence of atrial amyloidosis increase the risk of adverse cardiovascular outcomes in patients undergoing atrial fibrillation ablation?

Population

578 Japanese patients with non-valvular atrial fibrillation undergoing catheter ablation, free from prior cardiac amyloidosis diagnosis, followed for a mean of 33 months.

Exposure

Presence of atrial amyloidosis detected via intracardiac echocardiography-guided right atrial septal biopsy during AF ablation.

Comparator

Absence of atrial amyloidosis (non-CA) on right atrial biopsy.

Outcome

Composite of all-cause mortality, stroke, and hospitalization for heart failure following catheter ablation.composite

Main Result

Hazard Ratio: 2.71 (95% CI 1.1–6.7)

Limitations

Amyloid deposits other than ATTR may have been overlooked in cases with insufficient myocardial tissue
Relying exclusively on right atrial samples may have resulted in under-diagnosis
Lack of technetium-99m pyrophosphate scintigraphy in all cases raises the possibility of underdiagnosing ventricular amyloidosis
Follow-up period post-ablation was relatively short
Application of atrial biopsy in routine practice remains challenging due to the requirement for intracardiac echocardiography
Follow-up period post-ablation and biopsy was relatively short
Application of atrial biopsy in routine clinical practice remains challenging due to the requirement for intracardiac echocardiography
The clinical CA group was based on a retrospective analysis

Discussion

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Key expert perspectives

Captured external expert commentary on this paper, strongest first. Original sources are linked where available.

TY Takanori YamaguchiCardiovascular medicine, Saga University

“atrial biopsy detected atrial amyloidosis in ~7% of patients, often at an early stage, highlighting its potential for earlier diagnosis and intervention”

Saga UniversityEditorial

Implication

Atrial biopsy safely identifies early-stage cardiac amyloidosis in 7% of AF ablation patients, revealing a subset with advanced atrial cardiomyopathy and significantly worse cardiovascular outcomes.

Cite This Study

Shinzato et al. (2025) conducted a cohort in Non-valvular atrial fibrillation (n=578). Atrial amyloidosis (atrial biopsy-detected) vs. Absence of atrial amyloidosis (non-CA) was evaluated on Composite of all-cause mortality, stroke, and hospitalization for heart failure (adjusted hazard ratio 2.71, 95% CI 1.10-6.70). Atrial amyloidosis was found in 7% of AF ablation patients and independently increased the risk of death, stroke, and heart failure hospitalization (adjusted HR 2.71).

synapsesocial.com/papers/6a0bd69ce4a26ddc0cdc0545 https://doi.org/10.1093/eurheartj/ehaf332

Topics

Atrial fibrillation Persistent AF management Cardiac amyloidosis AF ablation outcomes Cardiomyopathy

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Implication

Atrial biopsy safely identifies early-stage cardiac amyloidosis in 7% of AF ablation patients, revealing a subset with advanced atrial cardiomyopathy and significantly worse cardiovascular outcomes.

Atrial amyloidosis identified by biopsy in atrial fibrillation: prevalence and clinical presentation

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Key expert perspectives

Implication

Cite This Study

Topics

Atrial amyloidosis identified by biopsy in atrial fibrillation: prevalence and clinical presentation

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Key expert perspectives

Implication

Cite This Study

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Topics

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