NYMC Faculty Publications

Cardiovascular Outcomes of Patients With Atrial Fibrillation and Concomitant Cardiac Amyloidosis Undergoing Percutaneous Catheter Ablation

Author Type(s)

Faculty

DOI

10.1016/j.cpcardiol.2024.102953

Journal Title

Current Problems in Cardiology

First Page

102953

Last Page

102953

Document Type

Review Article

Publication Date

3-2025

Department

Medicine

Keywords

Humans, Atrial Fibrillation, Amyloidosis, Aged, Catheter Ablation, Hospital Mortality, Aged, 80 and over, Cardiomyopathies, United States, Retrospective Studies, Treatment Outcome, Middle Aged, Risk Factors

Disciplines

Medicine and Health Sciences

Abstract

BACKGROUND: Atrial fibrillation has been linked with poor outcomes in patients with cardiac amyloidosis. We evaluate the in-hospital outcomes of patients with atrial fibrillation and concomitant cardiac amyloidosis with and without catheter ablation.

METHODS: The National Inpatient Sample databases (2016 to 2021) were queried to identify patients admitted with atrial fibrillation and concomitant cardiac amyloidosis using ICD 10 codes. The study population aged >18 years was divided into two cohorts; ablation (AB) vs. no ablation (NAB). Multivariate logistic regression model adjusting for baseline characteristics and comorbidities. The primary outcome was all-cause in-hospital mortality. Secondary outcomes were acute heart failure, cardiogenic shock, ventricular fibrillation, major bleeding, stroke, length of stay, and hospitalization cost.

RESULTS: 73,160 patients were identified. 595(0.8 %) underwent ablation and 72,656 (99.2 %) did not. Both NAB and AB patients were predominantly white (69.6 % and 60.3 %) respectively. AB patients were younger with median age [74 years (IQR 66-80) vs. 78 years (IQR 71-84), p < 0.01], compared with NAB patients. AB patients were more likely to have heart failure (76.5 % vs. 65.3 %, p = 0.04), and have a family history of CAD (11.1 % vs. 4.8 %, p = 0.03). Contrarily, NAB patients were more likely to have dementia (11.5 % vs. 2.5 %, p = 0.01). After adjusting for baseline characteristics and comorbidity, there was no difference in all-cause mortality (OR 0.3, CI 0.08-1.35, p = 0.12), stroke (OR 1.1, CI 0.4-2.8, p = 0.87), or major bleeding (OR 1.4, CI 0.7-2.6, p = 0.37). Undergoing ablation was associated with higher odds of acute heart failure (OR 1.9, CI 1.1-3.3, p< 0.01). After adjusting for inflation using the consumer price index, adjusted total cost of hospitalization was for higher AB patients was compared to NAB patients ($41,499.22 vs. $13,085.11) with a significantly longer length of stay among AB patients (7 days vs. 5days, p < 0.01).

CONCLUSION: Atrial fibrillation and concomitant cardiac amyloidosis in patients undergoing catheter ablation are associated with an increased risk of acute heart failure, higher cost, and a longer length of stay.

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