Related Experiment Video
Updated: Jan 7, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Comparative outcomes after atrial fibrillation catheter ablation in patients with cardiac amyloidosis: a multicenter
Ahmed K Mahmoud1,2, Ramzi Ibrahim3, Hoang Nhat Pham4,5
1Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA. Ahmed.mahmoud1@bmc.org.
Insights
Patients with transthyretin amyloid cardiomyopathy (ATTR-CM) undergoing atrial fibrillation (AF) ablation face higher risks of adverse events and hospitalizations compared to those without ATTR-CM. Careful risk stratification is crucial for optimizing management and outcomes in this population.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiomyopathy Research
Background:
- Atrial fibrillation (AF) is prevalent in transthyretin amyloid cardiomyopathy (ATTR-CM) due to cardiac infiltration and fibrosis.
- Management of AF in ATTR-CM patients is complex, with unclear comparative outcomes post-ablation.
Purpose of the Study:
- To compare the outcomes of AF ablation in patients with and without ATTR-CM.
- To identify risk factors and optimize management strategies for AF ablation in ATTR-CM.
Main Methods:
- Retrospective cohort study of adult patients undergoing AF ablation (2010-2024).
- Propensity score matching (1:1) to balance ATTR-CM and non-ATTR-CM cohorts.
- Primary composite outcome: cardioversion, antiarrhythmic initiation, or repeat ablation (3-12 months). Secondary outcomes: acute heart failure, hospitalizations, mortality.
Main Results:
- Matched cohorts (962 patients each) showed higher composite outcomes in ATTR-CM (37.2% vs. 29.3%).
- ATTR-CM cohort experienced increased rates of cardioversion, antiarrhythmic initiation, acute heart failure exacerbations, and hospitalizations.
- Significant differences observed in primary composite outcome (aHR 1.24, p=0.006) and secondary outcomes like AHF (p=0.003) and hospitalizations (p=0.003).
Conclusions:
- ATTR-CM patients undergoing AF ablation have significantly worse outcomes compared to non-ATTR-CM patients.
- Risk stratification is essential for managing AF ablation in ATTR-CM to improve patient outcomes.
- Further research may explore specific interventions to mitigate risks in this vulnerable population.
Introduction:
Atrial fibrillation (AF) is common in patients with transthyretin amyloid cardiomyopathy (ATTR-CM) due to amyloid infiltration and atrial fibrosis, complicating AF management. Although AF ablation has been studied within ATTR-CM populations, comparative outcomes between patients with and without ATTR-CM remain unclear.
Methods:
Adults undergoing AF ablation from 2010 to 2024 were identified and divided into ATTR-CM and non- ATTR-CM cohorts. Propensity score matching (1:1) balanced demographics, comorbidities, labs, and medications. The primary composite outcome included cardioversion, initiation of class I/III antiarrhythmics, or repeat ablation between 3 and 12 months post-procedure. Secondary outcomes included individual components, acute heart failure exacerbations (AHF), hospitalizations, and mortality. Statistical analyses involved chi-square, t-tests, Cox regression, and Kaplan-Meier survival curves.
Results:
After matching, 962 patients per cohort were analyzed (mean age 71, 23% female). The ATTR-CM cohort had higher rates of the composite outcome (37.2% vs. 29.3%, aHR 1.24; p = 0.006), cardioversion (13.7% vs. 8.3%, p = 0.001), antiarrhythmic initiation (30.8% vs. 23.9%, p = 0.012), AHF (22.5% vs. 15.5%, p = 0.003), and hospitalizations (39.5% vs. 30.7%, p = 0.003).
Conclusion:
Careful risk stratification is critical in ATTR-CM patients undergoing AF ablation to optimize management and outcomes.
