Catheter ablation for atrial arrhythmias in cardiac amyloidosis patients resulted in a 1-year recurrence rate of 40% for left atrial arrhythmias and 28% for typical atrial flutter.
Cohort (n=36)
Does catheter ablation prevent arrhythmia recurrence in patients with cardiac amyloidosis and atrial arrhythmias?
Catheter ablation provides reasonable 1-year arrhythmia control in cardiac amyloidosis patients, though long-term recurrence rates remain high and heart failure decompensation is a notable procedural complication.
Absolute Event Rate: 40% vs 28%
AbstractBackground Cardiac amyloidosis (CA) is characterized by atrial myopathy, which predisposes patients to atrial fibrillation (AF) and other atrial arrhythmias (AA). While catheter ablation of AA is effective in the general population, its efficacy and safety in CA patients remains unclear. Objective To evaluate outcomes in CA patients undergoing catheter ablation for typical atrial flutter (TAFL) and left atrial (LA) arrhythmias and to assess the presence and influence of LA low-voltage areas (LVA) in the latter. Methods We retrospectively analyzed CA patients undergoing first-time ablation for TAFL or LA arrhythmias (AF, atypical atrial flutter, focal tachycardia). For the latter group, LA electroanatomical mapping (EAM) quantified LVA burden and distribution. The primary outcome was arrhythmia recurrence at one year. Additionally, long-term outcomes over the maximum follow-up period were assessed and correlated with LVA. Results The cohort included 36 patients (TAFL in 11, LA arrhythmias in 25; mean age 74±7 years, 81% male, 64% wt-ATTR amyloidosis). Recurrence of any AA after one year occurred in 10 patients (40%) after LA arrhythmia ablation and in 3 patients (28%) after TAFL ablation (all new AA). LVA was seen in 73% of patients undergoing LA arrhythmia and it occupied 50.4% of the LA surface, most commonly the posterior wall (53%). However, its presence did not correlate with long-term arrhythmia-free survival (p=0.957). Procedure-related complications, particularly heart failure decompensation (16%), were important. Conclusion Catheter ablation provides reasonable 1-year arrhythmia control in CA patients experiencing TAFL or LA arrhythmias. However, long-term AA recurrence rates remain high.
Petzl et al. (2025) conducted a cohort in Cardiac amyloidosis with atrial arrhythmias (n=36). Catheter ablation vs. Typical atrial flutter ablation (vs LA arrhythmia ablation) was evaluated on Arrhythmia recurrence at one year. Catheter ablation for atrial arrhythmias in cardiac amyloidosis patients resulted in a 1-year recurrence rate of 40% for left atrial arrhythmias and 28% for typical atrial flutter.