What is the clinical evidence from this study?

Study design: Cohort. Population: Cardiac amyloidosis with atrial fibrillation (n=109). Intervention: Atrial fibrillation ablation. Primary outcome: Atrial arrhythmia (AA) recurrence and a composite of all-cause mortality and heart failure hospitalization (HFH).

What does this research mean for the field?

In patients with cardiac amyloidosis, catheter ablation achieves freedom from atrial arrhythmia in 42% of cases at two years, and recurrence of persistent AF is associated with a three-fold higher risk of heart failure hospitalization and death. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

June 1, 2026EP Europace0 citationsOpen Access

Catheter ablation of atrial fibrillation in transthyretin and light-chain cardiac amyloidosis: results from the multicentre AMYL-AF study

DFDaniele FaccendaEnte Ospedaliero Cantonale MBMarco BergontiEnte Ospedaliero Cantonale TPTom De PotterElectrophysiology

Key Result

AF ablation in cardiac amyloidosis had a 58.3% atrial arrhythmia recurrence rate; persistent AF recurrence was associated with a higher risk of death or heart failure (OR 2.9, P=0.02).

Study Design

Type

Cohort (n=109)

Multicenter

Yes

Structured PICO

Population

109 patients (mean age 72.4 years, 17.4% female) with transthyretin or light-chain cardiac amyloidosis undergoing atrial fibrillation ablation, followed for a median of 22.7 months.

Exposure

Catheter ablation of atrial fibrillation (radiofrequency 67%, cryo-balloon 15%, pulsed-field ablation 18%; 49.5% received pulmonary vein isolation plus additional ablations)

Outcome

Co-primary endpoints: (i) atrial arrhythmia (AA) recurrence; (ii) a composite endpoint of all-cause mortality and heart failure hospitalization (HFH)composite

In patients with cardiac amyloidosis undergoing atrial fibrillation ablation, freedom from atrial arrhythmia is achieved in 42% at nearly 2 years, but recurrence of persistent AF strongly predicts subsequent heart failure hospitalization and mortality.

Abstract

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.

Ask AI

Helpful

Bookmark

View Full Paper