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Updated: Jul 4, 2025
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Atrial electrofunctional predictors of incident atrial fibrillation in cardiac amyloidosis
Giulio Sinigiani1, Laura De Michieli1, Aldostefano Porcari2
1Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
Insights
In cardiac amyloidosis (CA) patients, older age, interatrial block (IAB), and reduced left atrial ejection fraction (LAEF) predict new-onset atrial fibrillation (AF). Closer AF screening is recommended for CA patients with these risk factors.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiovascular Imaging
Background:
- Atrial fibrillation (AF) is prevalent in cardiac amyloidosis (CA) and increases risks for heart failure hospitalization and thromboembolic events.
- Identifying predictors of AF in CA is crucial for risk stratification and management.
Purpose of the Study:
- To investigate atrial electrophysiological predictors of new-onset AF in patients with CA.
- To identify specific risk factors for incident AF in light-chain (AL) and transthyretin (ATTR) CA.
Main Methods:
- A multicenter observational study included 96 patients with AL-CA or ATTR-CA in sinus rhythm.
- Patients underwent electrocardiography and cardiac magnetic resonance imaging.
- Follow-up was conducted for a median of 18 months to record new-onset AF.
Main Results:
- 30% of patients developed incident AF over 18 months.
- Independent predictors of AF included older age (HR 1.059), any interatrial block (IAB) (HR 2.211), and lower left atrial ejection fraction (LAEF) (HR 0.967).
- Patients with IAB, LAEF <40%, and age >78 had a 40% cumulative incidence of AF at 12 months.
Conclusions:
- Older age, IAB on ECG, and reduced LAEF on CMR are significant independent predictors of incident AF in CA.
- Enhanced AF screening is advised for CA patients presenting with these identified risk factors.
Background:
Atrial fibrillation (AF) is common in patients with cardiac amyloidosis (CA) and is a significant risk factor for heart failure hospitalization and thromboembolic events.
Objective:
This study was designed to investigate the atrial electrofunctional predictors of incident AF in CA.
Methods:
A multicenter, observational study was conducted in 4 CA referral centers including sinus rhythm patients with light-chain (AL) and transthyretin (ATTR) CA undergoing electrocardiography and cardiac magnetic resonance imaging. The primary end point was new-onset AF occurrence.
Results:
Overall, 96 patients (AL-CA, n = 40; ATTR-CA, n = 56) were enrolled. During an 18-month median follow-up (Q1-Q3, 7-29 months), 30 patients (29%) had incident AF. Compared with those without AF, patients with AF were older (79 vs 73 years; P = .001). They more frequently had ATTR (87% vs 45%; P < .001); electrocardiographic interatrial block (IAB), either partial (47% vs 21%; P = .011) or advanced (17% vs 3%; P = .017); and lower left atrial ejection fraction (LAEF; 29% vs 41%; P = .004). Age (hazard ratio [HR], 1.059; 95% CI, 1.002-1.118; P = .042), any type of IAB (HR, 2.211; 95% CI, 1.03-4.75; P = .041), and LAEF (HR, 0.967; 95% CI, 0.936-0.998; P = .044) emerged as independent predictors of incident AF. Patients exhibiting any type of IAB, LAEF <40%, and age >78 years showed a cumulative incidence for AF of 40% at 12 months. This risk was significantly higher than that carried by 1 (8.5%) or none (7.6%) of these 3 risk factors.
Conclusion:
In patients with CA, older age, IAB on 12-lead electrocardiography, and reduced LAEF on cardiac magnetic resonance imaging are significant and independent predictors of incident AF. A closer screening for AF is advisable in CA patients carrying these features.
