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Introduction <p>Atrial fibrillation (AF) is common in patients with transthyretin amyloid cardiomyopathy (ATTR-CM) due to amyloid infiltration and atrial fibrosis, complicating AF management. Although AF ablation has been studied within ATTR-CM populations, comparative outcomes between patients with and without ATTR-CM remain unclear.</p> Methods <p>Adults undergoing AF ablation from 2010 to 2024 were identified and divided into ATTR-CM and non- ATTR-CM cohorts. Propensity score matching (1:1) balanced demographics, comorbidities, labs, and medications. The primary composite outcome included cardioversion, initiation of class I/III antiarrhythmics, or repeat ablation between 3 and 12 months post-procedure. Secondary outcomes included individual components, acute heart failure exacerbations (AHF), hospitalizations, and mortality. Statistical analyses involved chi-square, t-tests, Cox regression, and Kaplan-Meier survival curves.</p> Results <p>After matching, 962 patients per cohort were analyzed (mean age 71, 23% female). The ATTR-CM cohort had higher rates of the composite outcome (37.2% vs. 29.3%, aHR 1.24; <i>p</i> = 0.006), cardioversion (13.7% vs. 8.3%, <i>p</i> = 0.001), antiarrhythmic initiation (30.8% vs. 23.9%, <i>p</i> = 0.012), AHF (22.5% vs. 15.5%, <i>p</i> = 0.003), and hospitalizations (39.5% vs. 30.7%, <i>p</i> = 0.003).</p> Conclusion <p>Careful risk stratification is critical in ATTR-CM patients undergoing AF ablation to optimize management and outcomes.</p> Graphical Abstract <p></p>

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Comparative outcomes after atrial fibrillation catheter ablation in patients with cardiac amyloidosis: a multicenter propensity-matched analysis

  • 期刊论文

  • 发表日期：

    2025年12月26日

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  • Ahmed K. Mahmoud,
  • Ramzi Ibrahim,
  • Hoang Nhat Pham,
  • Mohammed Salih,
  • Justin Z. Lee,
  • Amin Al Ahmad,
  • Luis R. Scott,
  • Dan Sorajja,
  • Chadi Ayoub,
  • Reza Arsanjani

摘要

Introduction

Atrial fibrillation (AF) is common in patients with transthyretin amyloid cardiomyopathy (ATTR-CM) due to amyloid infiltration and atrial fibrosis, complicating AF management. Although AF ablation has been studied within ATTR-CM populations, comparative outcomes between patients with and without ATTR-CM remain unclear.

Methods

Adults undergoing AF ablation from 2010 to 2024 were identified and divided into ATTR-CM and non- ATTR-CM cohorts. Propensity score matching (1:1) balanced demographics, comorbidities, labs, and medications. The primary composite outcome included cardioversion, initiation of class I/III antiarrhythmics, or repeat ablation between 3 and 12 months post-procedure. Secondary outcomes included individual components, acute heart failure exacerbations (AHF), hospitalizations, and mortality. Statistical analyses involved chi-square, t-tests, Cox regression, and Kaplan-Meier survival curves.

Results

After matching, 962 patients per cohort were analyzed (mean age 71, 23% female). The ATTR-CM cohort had higher rates of the composite outcome (37.2% vs. 29.3%, aHR 1.24; p = 0.006), cardioversion (13.7% vs. 8.3%, p = 0.001), antiarrhythmic initiation (30.8% vs. 23.9%, p = 0.012), AHF (22.5% vs. 15.5%, p = 0.003), and hospitalizations (39.5% vs. 30.7%, p = 0.003).

Conclusion

Careful risk stratification is critical in ATTR-CM patients undergoing AF ablation to optimize management and outcomes.

Graphical Abstract