Atrial electrofunctional predictors of incident atrial fibrillation in cardiac amyloidosis

Heart Rhythm. 2024 Jun;21(6):725-732. doi: 10.1016/j.hrthm.2024.01.056. Epub 2024 Feb 2.

Abstract

Background: Atrial fibrillation (AF) is common in patients with cardiac amyloidosis (CA) and is a significant risk factor for heart failure hospitalization and thromboembolic events.

Objective: This study was designed to investigate the atrial electrofunctional predictors of incident AF in CA.

Methods: A multicenter, observational study was conducted in 4 CA referral centers including sinus rhythm patients with light-chain (AL) and transthyretin (ATTR) CA undergoing electrocardiography and cardiac magnetic resonance imaging. The primary end point was new-onset AF occurrence.

Results: Overall, 96 patients (AL-CA, n = 40; ATTR-CA, n = 56) were enrolled. During an 18-month median follow-up (Q1-Q3, 7-29 months), 30 patients (29%) had incident AF. Compared with those without AF, patients with AF were older (79 vs 73 years; P = .001). They more frequently had ATTR (87% vs 45%; P < .001); electrocardiographic interatrial block (IAB), either partial (47% vs 21%; P = .011) or advanced (17% vs 3%; P = .017); and lower left atrial ejection fraction (LAEF; 29% vs 41%; P = .004). Age (hazard ratio [HR], 1.059; 95% CI, 1.002-1.118; P = .042), any type of IAB (HR, 2.211; 95% CI, 1.03-4.75; P = .041), and LAEF (HR, 0.967; 95% CI, 0.936-0.998; P = .044) emerged as independent predictors of incident AF. Patients exhibiting any type of IAB, LAEF <40%, and age >78 years showed a cumulative incidence for AF of 40% at 12 months. This risk was significantly higher than that carried by 1 (8.5%) or none (7.6%) of these 3 risk factors.

Conclusion: In patients with CA, older age, IAB on 12-lead electrocardiography, and reduced LAEF on cardiac magnetic resonance imaging are significant and independent predictors of incident AF. A closer screening for AF is advisable in CA patients carrying these features.

Keywords: Atrial fibrillation; Cardiac amyloidosis; Cardiac magnetic resonance; Electrocardiogram; Interatrial block.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Aged
  • Amyloidosis / complications
  • Amyloidosis / diagnosis
  • Amyloidosis / epidemiology
  • Amyloidosis / physiopathology
  • Atrial Fibrillation* / complications
  • Atrial Fibrillation* / diagnosis
  • Atrial Fibrillation* / epidemiology
  • Atrial Fibrillation* / physiopathology
  • Cardiomyopathies* / diagnosis
  • Cardiomyopathies* / epidemiology
  • Cardiomyopathies* / etiology
  • Cardiomyopathies* / physiopathology
  • Electrocardiography*
  • Female
  • Follow-Up Studies
  • Heart Atria / diagnostic imaging
  • Heart Atria / physiopathology
  • Humans
  • Incidence
  • Magnetic Resonance Imaging, Cine / methods
  • Male
  • Risk Factors