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Atrial Fibrillation in the Elderly: The Role of Sub-Clinical Isolated Cardiac Amyloidosis

Darshan Krishnappa1,2, Richard Dykoski3, Ilknur Can1

  • 1Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota, USA.

Scientific Reports
|November 14, 2019
PubMed

Insights

Sub-clinical isolated cardiac amyloidosis (ICA) is present in 3.1% of patients and significantly increases the odds of atrial fibrillation (AF). ICA is linked to persistent AF and lower P-wave amplitude in patients with AF.

Area of Science:

  • Cardiology
  • Pathology
  • Geriatrics

Background:

  • Cardiac amyloidosis is linked to valvular heart disease and heart failure with preserved ejection fraction.
  • The association between amyloid deposits and atrial fibrillation (AF) in patients without valvular heart disease remains unclear.
  • Atrial fibrillation represents the most common form of AF globally.

Purpose of the Study:

  • To determine the prevalence of sub-clinical isolated cardiac amyloidosis (ICA) at autopsy.
  • To investigate the association between ICA and the odds of developing AF.

Main Methods:

  • Autopsy study of 1083 patients.
  • Analysis of ICA prevalence and correlation with AF, age, and CHA₂DS₂-VASc score.

Main Results:

  • 3.1% of patients exhibited asymptomatic ICA.
  • Patients with ICA were older and had increased odds of AF, independent of age and CHA₂DS₂-VASc score.
  • ICA was associated with persistent AF and reduced sinus rhythm P-wave amplitude.

Conclusions:

  • Sub-clinical ICA is present in a notable proportion of the general autopsy population.
  • ICA is an independent risk factor for AF and influences its clinical presentation.
  • Further research is needed for antemortem diagnosis and management strategies for ICA.

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