Efficacy and safety of catheter ablation for atrial arrhythmias in patients with cardiac amyloidosis: a systematic review and meta-analysis

Introduction Cardiac amyloidosis (CA) is a restrictive cardiomyopathy characterized by amylin deposits in the heart muscle. While the prevalence of atrial arrhythmias in CA is high, the data regarding the outcomes of catheter ablation in these patients are limited. This study aimed to elucidate the safety and efficacy of catheter ablation for treating atrial arrhythmias in patients with CA. Methods We conducted a comprehensive literature search across PubMed, Embase and Cochrane from inception till January 2024 for randomized control trials and observational studies reporting catheter ablation (cryoablation or radiofrequency ablation) for the treatment of atrial arrhythmias (AAs) (atrial flutter, atrial fibrillation, atrial tachycardia) in patients with cardiac amyloidosis. The primary outcome of interest was pooled recurrence rate. The secondary outcomes were re-ablation rate and all-cause mortality. All data were analyzed using the Hedges-Olkin random-effects model and presented as percentage proportions. Results A total of 9 cohort studies (n = 283) were included. The median age ranged from 67.6 years to 76.5 years, with a median follow-up of 13 to 60 months. The pooled incidence of recurrence rate was 45% (95% CI = 23.4% to 66.5%). The pooled proportion of re-ablation rate was 20% (95% CI = 3.3% to 36.7%) and of all-cause mortality was 30.7% (95% CI = 15.5% to 46%). Conclusions The high rates of recurrence, need for re-ablation, and associated mortality highlight the need for better patient selection. Prospective and randomized controlled data are needed to further study the outcomes of catheter ablation in these patients.