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Atrial amyloidosis identified by biopsy in atrial fibrillation: prevalence and clinical presentation
Kodai Shinzato1, Yuya Takahashi1, Takanori Yamaguchi1
1Department of Cardiovascular Medicine, Saga University, 5-1-1, Nabeshima, Saga 849-8501, Japan.
Insights
Atrial biopsy identified cardiac amyloidosis (CA) in 7% of patients with atrial fibrillation (AF) undergoing ablation. This method can detect early-stage CA, particularly in older patients with left ventricular hypertrophy.
Area of Science:
- Cardiology
- Pathology
- Biomarker Discovery
Background:
- Non-valvular atrial fibrillation (AF) is a common condition.
- Cardiac amyloidosis (CA) is an underdiagnosed infiltrative cardiomyopathy.
- Early detection of CA is crucial for timely intervention.
Purpose of the Study:
- To determine the prevalence of CA in patients with AF undergoing ablation.
- To evaluate the utility of atrial biopsy in identifying early-stage CA.
- To compare characteristics of patients with and without biopsy-detected CA.
Main Methods:
- Atrial biopsies were performed in 578 patients during AF ablation.
- Immunohistochemistry was used to assess amyloid type.
- Patients were categorized into atrial biopsy-detected CA (abio-CA), non-CA, and clinically diagnosed CA groups.
Main Results:
- Amyloid deposits were found in 7% of atrial biopsies, with ATTR being the most common type.
- CA prevalence increased with age, LV hypertrophy, and low-voltage areas.
- abio-CA patients had distinct LV posterior wall thickness and low-voltage area frequencies compared to non-CA and clinical CA groups.
- Right ventricular biopsy detected amyloid in 3% of patients, with some cases showing confined atrial amyloidosis.
Conclusions:
- Atrial biopsy is effective in detecting early-stage cardiac amyloidosis in patients with AF.
- A significant percentage of AF patients undergoing ablation have biopsy-confirmed CA.
- Atrial biopsy offers a valuable diagnostic tool for CA in this population.
Background And Aims:
This study aimed to assess the prevalence of cardiac amyloidosis (CA) in patients with non-valvular atrial fibrillation (AF) and to test the hypothesis that early-stage CA can be identified through atrial biopsy.
Methods:
Atrial biopsy was performed on 578 patients during AF ablation, with right ventricular (RV) biopsy conducted in 385 patients. The amyloid type was assessed using immunohistochemistry. Patients were classified into groups of atrial biopsy-detected CA (abio-CA) and non-CA, with an additional 58 patients clinically diagnosed with CA comprising the clinical CA group.
Results:
Amyloid deposits were identified in atrial samples from 40 patients (7%), including 25 amyloid transthyretin (ATTR) types. Prevalence increased to 20%-40% with advancing age, left ventricular (LV) hypertrophy, and the presence of low-voltage areas in the left atrium. The abio-CA group exhibited a thinner LV posterior wall (11.3 ± 2.2 vs 15.3 ± 4.6 mm, P < .001) compared with the clinical CA group. The abio-CA group displayed a thicker LV posterior wall (11.3 ± 2.2 vs 9.6 ± 1.4 mm, P < .001) and a higher frequency of low-voltage areas defined as <0.5 mV (45% vs 13%, P < .001) compared with the non-CA group. Right ventricular biopsy identified amyloid deposits in 13 patients (3%), comprising 11 ATTR and 2 light-chain types. Among the 26 patients in the abio-CA group who underwent RV biopsy, 13 had no amyloid deposits in RV samples, indicating confined atrial amyloidosis.
Conclusions:
Atrial biopsy revealed amyloid deposits in 7% of patients undergoing AF ablation, identifying early-stage CA.
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