JACC. Clinical electrophysiology · 2025
Catheter Ablation vs Antiarrhythmic Drug Therapy for Atrial Fibrillation in Cardiac Amyloidosis.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Tan Min Choon, Vignarajah Aravinthan, Teo Yong Shen, Vigneswaramoorthy Nishanthi, DeSimone Christopher V, Deshmukh Abhishek J, Sorajja Dan, Lee Justin Z
Аннотация
BACKGROUND: Atrial fibrillation (AF) is a common arrhythmia among patients with cardiac amyloidosis. Whereas the success rate of catheter ablation for AF may be lower due to amyloid deposition, the optimal approach to achieving rhythm control in these patients remains controversial.
OBJECTIVES: This study aims to assess the 3-year outcomes of catheter ablation for AF vs antiarrhythmic drug (AAD) therapy among patients with AF and cardiac amyloidosis using a multinational data set.
METHODS: Using the TriNetX Analytics Research Network, we included patients aged ≥18 years with a diagnosis of AF and amyloidosis between January 1, 2013, and January 1, 2021. Patients were further categorized into 2 groups: those who underwent catheter ablation for AF and those who were initiated on class I or III AAD. Patients with prior catheter ablation or class I /III AAD were excluded. The study outcomes included all-cause mortality and cardiac adverse events during a 3-year study period.
RESULTS: A total of 120 patients in the AF catheter ablation group and 4,749 in the AAD group were identified. After propensity score matching, 118 patients in each group were analyzed. Catheter ablation for AF in cardiac amyloidosis was associated with significantly lower risks of 3-year all-cause mortality (OR: 0.404; 95% CI: 0.182-0.896) and all-cause hospitalization (OR: 0.547; 95% CI: 0.317-0.942). However, no significant differences were observed in the risks of cerebrovascular attack (OR: 1; 95% CI: 0.400-2.500), cardiac arrest (OR: 1; 95% CI: 0.400-2.500), and acute heart failure (OR: 0.688; 95% CI: 0.293-1.617) between the 2 groups.
CONCLUSIONS: Catheter ablation for AF in patients with cardiac amyloidosis is associated with improved outcomes in all-cause mortality and hospitalization compared to AAD therapy. Further large-scale studies are needed to validate these potential benefits.
OBJECTIVES: This study aims to assess the 3-year outcomes of catheter ablation for AF vs antiarrhythmic drug (AAD) therapy among patients with AF and cardiac amyloidosis using a multinational data set.
METHODS: Using the TriNetX Analytics Research Network, we included patients aged ≥18 years with a diagnosis of AF and amyloidosis between January 1, 2013, and January 1, 2021. Patients were further categorized into 2 groups: those who underwent catheter ablation for AF and those who were initiated on class I or III AAD. Patients with prior catheter ablation or class I /III AAD were excluded. The study outcomes included all-cause mortality and cardiac adverse events during a 3-year study period.
RESULTS: A total of 120 patients in the AF catheter ablation group and 4,749 in the AAD group were identified. After propensity score matching, 118 patients in each group were analyzed. Catheter ablation for AF in cardiac amyloidosis was associated with significantly lower risks of 3-year all-cause mortality (OR: 0.404; 95% CI: 0.182-0.896) and all-cause hospitalization (OR: 0.547; 95% CI: 0.317-0.942). However, no significant differences were observed in the risks of cerebrovascular attack (OR: 1; 95% CI: 0.400-2.500), cardiac arrest (OR: 1; 95% CI: 0.400-2.500), and acute heart failure (OR: 0.688; 95% CI: 0.293-1.617) between the 2 groups.
CONCLUSIONS: Catheter ablation for AF in patients with cardiac amyloidosis is associated with improved outcomes in all-cause mortality and hospitalization compared to AAD therapy. Further large-scale studies are needed to validate these potential benefits.