Abstract 4145126: Catheter Ablation of Atrial Arrhythmias in Patients with Cardiac Amyloidosis

Background: Cardiac amyloidosis is an infiltrative disease that is associated with various atrial arrhythmias (AA). Data on the efficacy and safety of catheter ablation (CA) in this population is scarce, thus, we evaluated it in patients with cardiac amyloidosis. Methods: We performed a systematic review by searching for studies in all major databases. Random effect model was used to assess pooled incidence of outcomes with a 95% confidence interval (CI). Outcomes included 1) Freedom from AA; 2) Procedural complications (including pericardial effusion, cardiogenic shock and major bleeding); 3) Stroke during follow-up; 4) Cardiovascular hospitalization; 5) All-cause mortality. Results: 7 studies were included in the meta-analysis comprised 376 patients (mean age 71.24.9, 71% male, 95% atrial fibrillation (AF), 2% atrial flutter (AFL), <1% atrial tachycardia (AT), <1% AF/AFL, 3% AF/AT, 86% transthyretin amyloid). During a mean follow-up period of 29.6 months, freedom from AA was 42% (CI: 22-62%). Procedural complications, stroke during follow-up, cardiovascular hospitalization and all-cause mortality occurred in 3% (CI: 0-9%), 1% (CI: 0-2%), 10% (CI: 2-18%) and 17% (CI: 7-27), respectively (Figure). Conclusions: CA for AA in patients with cardiac amyloidosis is safe, despite high recurrence rates. Due to significant comorbidities in these patients, further studies are needed to evaluate for optimal treatment strategy for AA in patient with cardiac amyloidosis.