Catheter Ablation of Atrial Arrhythmias in Cardiac Amyloidosis: A Systematic Review and Meta-Analysis

Introduction Atrial arrhythmias (AA) are common in cardiac amyloidosis and are strongly associated with increased morbidity, heart failure hospitalizations, and thromboembolic events. Catheter ablation is increasingly performed, but its efficacy and safety in this population remain unclear. Methodology A systematic review and meta-analysis were conducted, including studies of adults with cardiac amyloidosis undergoing catheter ablation. Data extracted included baseline characteristics, arrhythmia type, ablation modality, and follow-up duration. In the single-arm analysis, outcomes were recurrence of atrial arrhythmias and time to recurrence. For the comparative analysis, outcomes were heart failure hospitalization and all-cause mortality. Pooled incidence rates were calculated per 100 person-years for single-arm studies, while comparative studies (ablation vs. no ablation) were analyzed using random-effects models to generate risk ratios (RR) and hazard ratios (HR) with 95% confidence intervals. Results Ten studies (233 patients, 91% ATTR-CM) were included. The pooled arrhythmia recurrence rate was 35.1 per 100 person-years (95% CI: 19.4-63.3), with a mean time to recurrence of 12 months (95% CI: 5.4-18.6). In comparative analyses (3 studies, 286 patients), catheter ablation significantly reduced heart failure hospitalizations (RR 0.44, 95% CI: 0.38-0.51) and all-cause mortality (HR 0.42, 95% CI: 0.24-0.73). Conclusion Catheter ablation in cardiac amyloidosis is associated with moderate recurrence rates but marked reductions in HF hospitalization and mortality, particularly in early disease stages. These findings support ablation as a valuable rhythm control strategy, though prospective trials are needed to confirm its role.