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Outcomes in patients with cardiac amyloidosis undergoing catheter ablation for atrial arrhythmias

Adrian M Petzl1, Justice Oranefo1, Alireza Oraii1

  • 1Cardiac Electrophysiology Section, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

Heart Rhythm O2
|September 8, 2025
PubMed

Insights

Catheter ablation offers short-term control for atrial arrhythmias in cardiac amyloidosis patients. However, long-term recurrence rates for atrial arrhythmias remain high, indicating a need for further research.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Cardiac Amyloidosis Research

Background:

  • Cardiac amyloidosis (CA) is linked to atrial myopathy, increasing risk for atrial fibrillation (AF) and atrial arrhythmias (AA).
  • The effectiveness and safety of catheter ablation for AA in CA patients are not well-established.

Purpose of the Study:

  • To evaluate catheter ablation outcomes for typical atrial flutter (TAFL) and left atrial (LA) arrhythmias in CA patients.
  • To assess the prevalence and impact of LA low-voltage areas (LVA) in this cohort.

Main Methods:

  • Retrospective analysis of 36 CA patients undergoing first-time ablation for TAFL or LA arrhythmias.
  • Left atrial electroanatomical mapping (EAM) to quantify LVA burden and distribution.
  • Primary outcome: arrhythmia recurrence at 1 year; secondary outcome: long-term outcomes correlated with LVA.

Main Results:

  • One-year recurrence rates were 40% for LA arrhythmias and 28% for TAFL.
  • LVA was present in 73% of LA arrhythmia patients, averaging 50.4% of the LA surface.
  • LVA presence did not correlate with long-term arrhythmia-free survival; significant complications included heart failure decompensation (16%).

Conclusions:

  • Catheter ablation provides acceptable 1-year arrhythmia control for TAFL and LA arrhythmias in CA patients.
  • High rates of long-term atrial arrhythmia recurrence persist, underscoring challenges in managing these patients.
Abstract

Keywords:
Atrial fibrillationAtrial scarAtypical atrial flutterCardiac amyloidosisCatheter ablationElectroanatomic mappingPulmonary vein isolation

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