Key result
AF ablation in cardiac amyloidosis yields ~58% arrhythmia recurrence over nearly two years.
Why the study?
Atrial fibrillation is highly prevalent in cardiac amyloidosis and contributes significantly to morbidity and mortality, but evidence regarding AF ablation efficacy and safety in this population remains limited.
What are the outcomes of atrial fibrillation catheter ablation in patients with cardiac amyloidosis?
Observational (n=109)
Yes
What are the outcomes of atrial fibrillation catheter ablation in patients with cardiac amyloidosis?
Despite a high rate of arrhythmia recurrence following catheter ablation in patients with cardiac amyloidosis, ablation may reduce atrial fibrillation burden, and avoiding persistent atrial fibrillation recurrence is linked to reduced heart failure hospitalizations and mortality.
High atrial arrhythmia recurrence after ablation in cardiac amyloidosis warrants caution in patient selection; leaves open whether rhythm control improves hard outcomes.
AIMS: Atrial fibrillation (AF) is highly prevalent among cardiac amyloidosis (CA) patients and contributes significantly to their morbidity and mortality. Evidence regarding AF ablation efficacy and safety in CA patients remains limited. The aim of our study is to evaluate baseline characteristics, clinical course and outcomes of AF ablation in a series of patients with transthyretin (ATTR) or light-chain (AL) CA from a multicentre international registry. METHODS AND RESULTS: Patients with CA who underwent AF ablation were included. Co-primary endpoints were: (i) atrial arrhythmia (AA) recurrence; (ii) a composite endpoint of all-cause mortality and heart failure hospitalization (HFH). 109 patients (mean age 72.4 ± 7.4 years, females 17.4%, persistent AF 64.2%, ATTR 78%, AL 22%) were included. Radiofrequency, cryo-balloon and pulsed-field ablation were performed in 67%, 15% and 18% of patients, respectively; 49.5% received pulmonary vein isolation plus additional ablations. Low voltage zones were documented in 34 out of 44 patients undergoing electro-anatomical mapping (77.3%). During a median follow-up of 22.7 months, 63 patients (58.3%) experienced AA recurrence (32.4% persistent AF recurrence), with no significant differences between CA subtypes (ATTR 59.5% vs. AL 54.2%, log-rank P = 0.55). The composite endpoint of HFH and all-cause death occurred in 27 patients (25%). Recurrence of persistent AF was associated with three-fold higher risk (OR 2.9, P = 0.02) of the composite endpoint. CONCLUSION: CA patients undergoing AF ablation present high prevalence of persistent AF. Freedom from AA after AF ablation is achieved in 42% of patients after a two-year follow-up. Patients with persistent AF recurrence have a three-fold higher risk of HFH and death.
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Faccenda et al. (2026) conducted an observational in Atrial fibrillation and cardiac amyloidosis (n=109). Catheter ablation for atrial fibrillation was evaluated on Atrial arrhythmia recurrence. In patients with cardiac amyloidosis, catheter ablation for atrial fibrillation resulted in an atrial arrhythmia recurrence rate of 58.3% over a median follow-up of 22.7 months.
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