Why the study?
Diagnosis of infiltrative cardiomyopathies has increased and catheter ablation is preferred for managing AF in these patients, but procedural differences compared to patients without infiltrative cardiomyopathies remain poorly characterized.
Does the presence of cardiac amyloidosis or cardiac sarcoidosis affect intraprocedural findings (non-PV triggers and macro-reentrant flutters) and 1-year arrhythmia recurrence rates in patients undergoing first-time catheter ablation for atrial fibrillation compared to matched controls?
Does the presence of cardiac amyloidosis or cardiac sarcoidosis affect intraprocedural findings (non-PV triggers and macro-reentrant flutters) and 1-year arrhythmia recurrence rates in patients undergoing first-time catheter ablation for atrial fibrillation compared to matched controls?
Patients with cardiac amyloidosis and sarcoidosis undergoing first-time AF ablation have higher rates of left atrial low voltage areas and non-PV triggers, and despite targeted ablation of these triggers, cardiac amyloidosis patients still experience significantly higher 1-year arrhythmia recurrence than matched controls while cardiac sarcoidosis patients achieve comparable outcomes.
Answers are grounded in this paper and cite their sources.
Anticipate more complex first-time AF ablation and counsel higher recurrence in amyloidosis; leaves open extra-PV strategies.
AIMS: The diagnosis of infiltrative cardiomyopathies has increased over last years. Catheter ablation is becoming the preferred approach for managing atrial fibrillation (AF) in these patients. This study aims to characterize differences in procedural findings during AF ablation in patients with and without infiltrative cardiomyopathies. METHODS AND RESULTS: Patients with cardiac amyloidosis and cardiac sarcoidosis undergoing first-time AF ablation were propensity score matched in 1:4 ratio to separate reference groups that received trigger provocative manoeuvres (isoproterenol infusion and/or atrial burst pacing) and had no prior cardiac surgery. Non-pulmonary vein (PV) triggers [defined as ectopic foci initiating AF or sustained focal atrial tachycardia (AT)] and macro-reentrant atrial flutters (AFLs) were then mapped and targeted. Recurrence was defined as AF/AT/AFL ≥ 30 s after 90-day blanking period. Twenty-four patients with cardiac amyloidosis were matched to 96 controls, and 17 patients with cardiac sarcoidosis were matched to 68 controls. Non-PV triggers were more frequent in patients with cardiac amyloidosis {29.2% vs. 8.3%; odds ratio [OR] = 4.5 [95% confidence interval (CI): 1.4-14.2]} and cardiac sarcoidosis [17.6% vs. 7.4%; OR = 2.7 (95% CI: 0.6-12.6)] compared with their reference groups. Patients with cardiac amyloidosis also had a higher incidence of left atrial macro-reentrant flutters [37.5% vs. 6.3%; OR = 9.0, (95% CI: 2.8-29.0)]. One-year recurrence rate was similar between patients with cardiac sarcoidosis and controls (33.3% vs. 33.9%; P = 0.965) but higher in patients with cardiac amyloidosis vs. controls (47.4% vs. 27.1%; P = 0.049). CONCLUSION: Patients with infiltrative cardiomyopathies exhibit higher rates of non-PV triggers and left AFLs during first-time AF ablation. Those with cardiac amyloidosis experience higher arrhythmia recurrence rates compared with controls.
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Oraii et al. (2025) studied this question.
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