Catheter ablation versus no ablation for atrial fibrillation in cardiac amyloidosis: a propensity-matched cohort study.

BACKGROUND

Atrial fibrillation (AF) is extremely common in cardiac amyloidosis (CA) due to amyloid infiltration and atrial electrical remodeling. We aim to compare ablation outcomes versus no-ablation in patients taking anti-arrhythmic drugs (AAD) in CA-associated AF.

METHODS

Using TriNetX database (2019-2025), 5,562 patients with CA and AF were identified and divided into two groups: catheter ablation plus AADs (n = 893) versus medical therapy alone (n = 4,669). Baseline characteristics were adjusted and 1:1 propensity score matching was performed to account for baseline differences. Primary composite outcome included all-cause mortality, ischemic strokes, bleeding and subsequent myocardial infarction.

RESULTS

870 patients were included in each cohort. At 12-month follow-up, catheter ablation was associated with a significantly lower risk of the composite outcome (8.3% vs 13.2%; HR 0.591, 95% CI [0.418-0.834], p = 0.002), and reduced all-cause mortality. There were no significant differences in all-cause hospitalization, emergency department visits, new-onset heart failure, atrioventricular block, or cardiac arrest. Repeat ablation or cardioversion, and subsequent pacemaker or ICD implantation were more frequent in the ablation group.

CONCLUSION

Catheter ablation was associated with improved short-term outcomes despite higher arrhythmia recurrence. Ablation may be considered in carefully selected patients, particularly those with earlier-stage disease or significant symptoms.