Conference Coverage

Catheter Ablation Associated With Lower Mortality, Stroke Risk in Cardiac Amyloidosis Patients With Atrial Fibrillation

Edited by:
Kate Young

Key Highlights:

  • Catheter ablation was associated with significantly lower all-cause mortality compared with no ablation in patients with cardiac amyloidosis and atrial fibrillation.
  • Stroke occurred less frequently among patients who underwent catheter ablation.
  • Atrial fibrillation recurrence was more common in the ablation group despite improved survival outcomes.
  • Rates of cardiogenic shock were similar between groups.

Patients with cardiac amyloidosis frequently develop atrial myopathy, increasing their risk for atrial fibrillation and flutter. New research presented at the American College of Cardiology’s Annual Scientific Session suggests catheter ablation was associated with significantly lower mortality and reduced stroke risk among patients with cardiac amyloidosis and atrial fibrillation compared with those who did not undergo catheter ablation.

Researchers conducted a retrospective cohort study using the TriNetX US Collaborative Network database. Adults with cardiac amyloidosis and atrial fibrillation were identified and divided into two groups: those who underwent catheter ablation and those who did not receive the procedure.

To minimize baseline differences between groups, investigators performed 1:1 propensity score matching. After matching, each cohort included 814 patients, with a mean age of 73 years. The study’s primary endpoint was all-cause mortality, while secondary endpoints included heart failure, cardiogenic shock, recurrence of atrial fibrillation, and stroke.

Study Findings

Catheter ablation was associated with a significantly lower rate of all-cause mortality compared with no ablation. Mortality occurred in 15.6% of patients in the ablation group versus 26.3% among those who did not undergo the procedure (risk ratio [RR], 0.593; 95% CI, 0.487–0.723; P < 0.0001).

Stroke also occurred less frequently among patients who underwent catheter ablation. Stroke rates were 8.2% in the ablation cohort compared with 11.5% in the non-ablation group (RR, 0.713; 95% CI, 0.529–0.96; P = 0.025).

However, atrial fibrillation recurrence was more common among patients who received catheter ablation. Recurrence occurred in 90.9% of the ablation group compared with 78.4% in those who did not undergo the procedure (RR, 1.16; 95% CI, 1.112–1.21; P < 0.0001).

Rates of cardiogenic shock were similar between the two groups, occurring in 7.4% of patients who underwent ablation and 8.0% of those who did not (RR, 0.923; P = 0.642). Heart failure incidence was slightly higher in the ablation cohort (82.7% vs 79.2%), though the difference did not reach statistical significance (RR, 1.043; P = 0.0772).

Clinical Implications

According to the study authors, the findings suggest that catheter ablation may offer meaningful long-term benefits for patients with cardiac amyloidosis and atrial fibrillation, particularly in reducing mortality and stroke risk. These results highlight the potential advantages of rhythm-control strategies in this population despite the high burden of atrial arrhythmia recurrence observed after ablation.

Expert Commentary

“In this large, real-world, propensity-matched cohort study, catheter ablation in patients with cardiac amyloidosis was associated with significantly lower all-cause mortality and reduced stroke risk compared to non-ablated atrial fibrillation patients,” the researchers concluded. “Although AF/flutter recurrence remained higher in the ablation group, likely reflecting frequent post-procedural follow-up, the association of lower mortality and stroke highlights the potential long-term advantages of rhythm control in cardiac amyloidosis.”

Reference
Sabri MS, Sharma S, Patel M, Hawwa N, Haas DC. Targeting the rhythm: catheter ablation outcomes in cardiac amyloidosis and atrial arrhythmias. Presented at: American College of Cardiology Annual Scientific Session (ACC.26); March 28–30, 2026; New Orleans, LA. https://cattendee.abstractsonline.com/meeting/21230/presentation/7229