Catheter Ablation of Atrial Fibrillation in Infiltrative Cardiomyopathies: A Narrative Review

Area of Science:

• Cardiology
• Electrophysiology
• Infiltrative Cardiomyopathies

Background:

• Infiltrative heart diseases, including amyloidosis, sarcoidosis, and hemochromatosis, frequently present with atrial and ventricular arrhythmias.
• Atrial fibrillation (AF) is the most prevalent arrhythmia in these conditions, driven by myocardial infiltration, dilation, and scarring.

Purpose of the Study:

• To review and synthesize current knowledge on ablative techniques for treating arrhythmias, particularly AF, in patients with infiltrative cardiomyopathies.
• To evaluate the safety and efficacy of catheter ablation for AF in specific infiltrative heart diseases and identify areas for future research.

Main Methods:

• A comprehensive literature review of the MEDLINE database was performed.
• Synthesized data on ablative techniques, focusing on outcomes and complications in patients with cardiac amyloidosis, sarcoidosis, hemochromatosis, and glycogen storage disorders.

Main Results:

• Catheter ablation shows promise for AF treatment in infiltrative cardiomyopathies, with studies indicating lower mortality and admission rates in amyloidosis, though with some conflicting data on complications.
• Encouraging outcomes and low recurrence rates are reported for AF ablation in cardiac sarcoidosis, with comparable complication rates to non-sarcoidosis patients.
• Limited data exist on ablation for AF in hereditary hemochromatosis and glycogen storage disorders, with chelation being the primary management for HH-related AF.

Conclusions:

• Catheter ablation is a safe and effective treatment option for atrial fibrillation in patients with infiltrative cardiomyopathy.
• Further large-scale clinical trials are essential to validate these findings and establish definitive guidelines for managing arrhythmias in these specialized patient populations.