Clinical outcomes of catheter ablation for atrial fibrillation, atrial flutter, and atrial tachycardia in wild-type transthyretin amyloid cardiomyopathy: a proposed treatment strategy for catheter ablation in each arrhythmia

Kanazawa, H; Takashio, S; Hoshiyama, T; Ito, M; Kaneko, S; Kiyama, T; Kawahara, Y; Sumi, H; Tsuruta, Y; Kuyama, N; Hirakawa, K; Ishii, M; Tabata, N; Yamanaga, K; Fujisue, K; Hanatani, S; Sueta, D; Arima, Y; Araki, S; Matsuzawa, Y; Usuku, H; Nakamura, T; Yamamoto, E; Soejima, H; Matsushita, K; Tsujita, K

doi:10.1093/europace/euae155

Heart failure & cardiomyopathies

Clinical outcomes of catheter ablation for atrial fibrillation, atrial flutter, and atrial tachycardia in wild-type transthyretin amyloid cardiomyopathy: a proposed treatment strategy for catheter ablation in each arrhythmia

EuropacePublished 27 Jun 2024Cohort study

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Authors' conclusion

The outcomes of CA for ATTRwt-CM were acceptable, except for multiple focal AT and complex AFL.

Study context

Population: Patients with wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM)54 underwent catheter ablation (CA)
Participants: 233 patients

Exposure: CA vs no CA
CAn = 54
Outcome: Outcomes of CA for AF/AFL/AT:
Recurrence-free rate
All-cause mortality
CV mortality
Heart failure (HF) hospitalization

Main finding

As reported in the abstract

CA

Recurrence-free rate of atrial fibrillation (AF)/atrial flutter (AFL)/atrial tachycardia (AT) (multiple CA), 1 year: 70.1%
Recurrence-free rate, 2 years: 57.6%
Recurrence-free rate, 5 years: 44.0%

CA

Recurrence-free rate of atrial fibrillation (AF)/atrial flutter (AFL)/atrial tachycardia (AT) (multiple CA), 1 year70.1%

Recurrence-free rate, 2 years57.6%

Recurrence-free rate, 5 years44.0%

CA vs Without CAHazard ratio (95% CI)P value

All-cause mortality

0.342(0.133–0.876)

P = 0.025

CV mortality

0.378(0.146–0.981)

P = 0.045

HF hospitalization

0.488(0.269–0.889)

P = 0.019

Observational data: associations, not effects.

Further findings

Recurrence by arrhythmia type

Paroxysmal AF without AF recurrence: 12 of 13
Persistent AF without AF recurrence: 27 of 29
Non-CTI-dependent complex AFL recurred: all three
Focal AT or multiple focal ATs beyond atrioventricular (AV) annulus or crista terminalis recurred: 10 of 13
No recurrence: Cavotricuspid isthmus (CTI)-dependent AFL, non-CTI-dependent simple AFL terminated by one linear ablation, focal AT from AV annulus or crista terminalis

Even after multiple CA

Original publication

Clinical outcomes of catheter ablation for atrial fibrillation, atrial flutter, and atrial tachycardia in wild-type transthyretin amyloid cardiomyopathy: a proposed treatment strategy for catheter ablation in each arrhythmia. Europace. Published 27 June 2024. doi:10.1093/europace/euae155

Read the original article ↗

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