Atrial Fibrillation Burden, Risk Factors, and Prognosis in Wild-type Transthyretin Amyloidosis Cardiomyopathy

Atrial fibrillation (AF) is common in patients with wild-type transthyretin amyloidosis (ATTRwt), yet data on incident AF following diagnosis, associated risk factors, and its prognostic impact remain limited. In this single-centre cohort study conducted at Aarhus University Hospital, we examined the incidence of new-onset AF, identified clinical predictors, and explored the association between AF and all-cause mortality in patients with ATTRwt diagnosed between 2016 and 2022. Among 208 patients, AF was present at diagnosis in 56%, and the cumulative incidence of new-onset AF in the remaining patients reached 45% (95% CI: 32% to 56%) at three years after diagnosis. Multivariable Cox regression identified body mass index (HR 1.13, 95% CI 1.04 to 1.23), higher National Amyloidosis Centre stage (HR 1.93, 95% CI 1.14 to 3.27), and left ventricular mass index per 10-unit increase (HR 1.06, 95% CI 1.01 to 1.12) as significant risk factors of new-onset AF. A clinical history of AF at the time of ATTRwt diagnosis seemed to be associated with increased all-cause mortality, but did not reach statistical significance (HR 1.74, 95% CI 0.96 to 3.16, p = 0.07). In conclusion, AF is highly prevalent at diagnosis and frequently develops after diagnosis in patients with ATTRwt, with body mass index, National Amyloidosis Centre stage, and increasing left ventricular mass index emerging as risk factors for new-onset AF. Having AF is likely associated with adverse prognostic implications warranting further investigation.