What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Cardiac amyloidosis and atrial fibrillation (n=797). Intervention: Catheter ablation vs. Medical therapy. Primary outcome: Freedom from atrial arrhythmia (AA) following ablation (50%, 95% CI 37%-63%).

What does this research mean for the field?

In patients with cardiac amyloidosis and atrial fibrillation, catheter ablation achieves approximately 50% freedom from atrial arrhythmia and is associated with significantly lower odds of all-cause mortality compared with medical therapy. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

August 1, 2026Journal of ArrhythmiaOpen Access

Catheter Ablation for Atrial Fibrillation in Cardiac Amyloidosis: A Systematic Review and Meta‐Analysis

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Key result

Catheter ablation achieves ~50% freedom from atrial arrhythmias and lower mortality in cardiac amyloidosis.

50%
95% CI 37%-63%
n=797

Why the study?

Catheter ablation is increasingly used for rhythm control in patients with cardiac amyloidosis and atrial fibrillation, but its clinical outcomes remain uncertain.

Does catheter ablation improve freedom from atrial arrhythmia and reduce adverse clinical outcomes in patients with cardiac amyloidosis and atrial fibrillation?

Study Design

Type

Meta-Analysis (n=797)

Structured PICO

Does catheter ablation improve freedom from atrial arrhythmia and reduce adverse clinical outcomes in patients with cardiac amyloidosis and atrial fibrillation?

Population

797 patients with cardiac amyloidosis and atrial fibrillation from 13 observational studies, predominantly male, followed for 11.9 to 60 months.

Intervention

Catheter ablation (radiofrequency or cryoballoon) for atrial arrhythmias

Comparator

Medical therapy (non-ablative management)

Outcome

Freedom from atrial arrhythmia (AA) following catheter ablation

Main Result

Effect estimate: 50% (95% CI 37%-63%)

In patients with cardiac amyloidosis and atrial fibrillation, catheter ablation provides modest arrhythmia-free survival and is associated with lower all-cause mortality compared to medical therapy, though findings are limited by the observational nature of the data.

Limitations

All included studies are observational and non-randomized cohorts subject to major selection bias and indication bias
Primary comparative analysis was based on crude event-count odds ratios
Disease-modifying therapy represents a critical potential confounder that could not be adequately addressed
Very Low certainty of evidence per GRADE criteria
All included studies are observational and non-randomized cohorts subject to major selection bias and indication bias.
Primary comparative analysis was based on crude event-count odds ratios.
Inability to adequately address confounding by disease-modifying therapy (e.g., tafamidis).
Variations in definitions of arrhythmia recurrence, ablation technique, follow-up duration, and rhythm monitoring intensity.
Limited event counts for heart failure hospitalization and stroke.

Implication

May support ablation for arrhythmia control in cardiac amyloidosis; leaves open confirmation of mortality benefit in randomized trials.

Abstract

Background Atrial fibrillation (AF) is prevalent in cardiac amyloidosis (CA) and is associated with adverse clinical outcomes. Catheter ablation is increasingly used for rhythm control in this population, yet its clinical outcomes remain uncertain. We performed a systematic review and meta‐analysis to evaluate arrhythmia recurrence and clinical outcomes following catheter ablation compared with medical therapy in patients with CA. Methods We systematically searched MEDLINE, Embase, and Scopus from inception through December 2025 for studies evaluating catheter ablation of atrial arrhythmias in CA. Cohort studies reporting arrhythmia recurrence and/or clinical outcomes were included. The primary outcome was freedom from atrial arrhythmia (AA) following ablation. Secondary outcomes included all‐cause mortality, heart failure hospitalization, and stroke. Random‐effects models were used to pool event rates and odds ratios (ORs). Results Thirteen observational studies comprising 797 patients with CA and AF were included. The pooled rate of freedom from AA following catheter ablation was approximately 50% (95% CI 37%–63%; I 2 = 71.7%). The all‐cause mortality analysis included 4 observational studies comprising 616 patients. Catheter ablation was associated with lower odds of all‐cause mortality (OR 0.26, 95% CI 0.11–0.60; I 2 = 18.4%); however, this association should be interpreted with caution given the retrospective design and risk of bias. No statistically significant differences were observed for heart failure hospitalization or stroke. Conclusions In patients with CA, catheter ablation was associated with modest arrhythmia‐free survival and lower odds of all‐cause mortality. However, all contributing studies were observational cohorts. Randomized studies are needed to confirm these findings.

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Published by Journal of Arrhythmia · CC BY-NC-ND

Cite This Study

Sripusanapan et al. (2026) conducted a meta-analysis in Cardiac amyloidosis and atrial fibrillation (n=797). Catheter ablation vs. Medical therapy was evaluated on Freedom from atrial arrhythmia (AA) following ablation (50%, 95% CI 37%-63%). Catheter ablation was associated with a 50% pooled rate of freedom from atrial arrhythmia and lower odds of all-cause mortality compared with medical therapy in patients with cardiac amyloidosis.

synapsesocial.com/papers/6ab5dbe5f0c285845c862d17 https://doi.org/10.1002/joa3.70441