{"id":"4e5431aaff01","type":"article","url":"https://hartvaat.nl/2026/06/02/catheterablatie-bij-atriumfibrilleren-in-cardiale-amyloidose-levert-42-ritmievri/","title":"Catheterablatie bij atriumfibrilleren in cardiale amyloïdose levert 42% ritmievrije patiënten op — AMYL-AF","title_en":"Catheter ablation of atrial fibrillation in transthyretin and light-chain cardiac amyloidosis: results from the multicentre AMYL-AF study.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","internist"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euag143","source_url":"https://doi.org/10.1093/europace/euag143","authors":["Daniele Faccenda","Marco Bergonti","Tom De Potter","Michel Haïssaguerre","Johan Saenen","Carlo De Asmundis","Giuseppe Ciconte","Marta De Riva","Michela Casella","Jacopo Costantino","Daniel Scherr","Mikael Laredo","Patrizio Mazzone","Avi Sabbag","Matteo Anselmino","Andrea Rossi","Matteo Bertini","Lia Crotti","Christian-Hendrik Heeger","Claudio Tondo","Elena Arbelo","Moises Levinstein","Sebastiaan R D Piers","Maria L Caputo","Carlo Pappone","Domenico G Della Rocca","Olivier Van Leuven","Paolo Compagnucci","Tardu Özkartal","Raffaele Salerno","Chiara Pavone","Valeria Rella","Katharina I Gölly","Lorenzo Gigli","Cristina Balla","Cristina Chimenti","Nicolas Johner","Alessandro Laschera","Manuela Averaimo","Esther Scheirlynck","Marco Schiavone","Cinzia Monaco","Giulio Conte"],"significance":5,"published":"2026-08-11","source_date":"2026-06-02","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/atriumfibrilleren/af-en-hartfalen/"],"congress":"","summary_en":"The multicentre AMYL-AF registry evaluated catheter ablation outcomes in 109 patients with transthyretin (ATTR) or light-chain (AL) cardiac amyloidosis and atrial fibrillation. After a median follow-up of 22.7 months, 42% remained arrhythmia-free, while 25% experienced the composite endpoint of all-cause mortality or heart failure hospitalisation. Recurrent persistent AF was associated with a three-fold higher risk of these adverse outcomes. These real-world data assist cardiologists and internists in counselling patients and selecting appropriate rhythm-control strategies in this high-risk population.","created":"2026-08-05T01:04:07Z","updated":"2026-08-10T10:36:04Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"In het multicentre AMYL-AF-register werden 109 patiënten met transthyretine- (ATTR) of lichtketen- (AL) cardiale amyloïdose en atriumfibrilleren onderzocht op de effectiviteit van catheterablatie. Na een mediane follow-up van 22,7 maanden bleef 42% van de patiënten ritmievrij, terwijl 25% overleed of werd opgenomen voor hartfalen. Een recidief van persistent atriumfibrilleren ging gepaard met een drievoudig hoger risico op deze zware uitkomsten. Deze bevindingen helpen cardiologen en internisten bij het afwegen van ablatie als behandeloptie in deze kwetsbare populatie.","abstract_original":"AIMS: Atrial fibrillation (AF) is highly prevalent among cardiac amyloidosis (CA) patients and contributes significantly to their morbidity and mortality. Evidence regarding AF ablation efficacy and safety in CA patients remains limited. The aim of our study is to evaluate baseline characteristics, clinical course and outcomes of AF ablation in a series of patients with transthyretin (ATTR) or light-chain (AL) CA from a multicentre international registry. METHODS AND RESULTS: Patients with CA who underwent AF ablation were included. Co-primary endpoints were: (i) atrial arrhythmia (AA) recurrence; (ii) a composite endpoint of all-cause mortality and heart failure hospitalization (HFH). 109 patients (mean age 72.4 ± 7.4 years, females 17.4%, persistent AF 64.2%, ATTR 78%, AL 22%) were included. Radiofrequency, cryo-balloon and pulsed-field ablation were performed in 67%, 15% and 18% of patients, respectively; 49.5% received pulmonary vein isolation plus additional ablations. Low voltage zones were documented in 34 out of 44 patients undergoing electro-anatomical mapping (77.3%). During a median follow-up of 22.7 months, 63 patients (58.3%) experienced AA recurrence (32.4% persistent AF recurrence), with no significant differences between CA subtypes (ATTR 59.5% vs. AL 54.2%, log-rank P = 0.55). The composite endpoint of HFH and all-cause death occurred in 27 patients (25%). Recurrence of persistent AF was associated with three-fold higher risk (OR 2.9, P = 0.02) of the composite endpoint. CONCLUSION: CA patients undergoing AF ablation present high prevalence of persistent AF. Freedom from AA after AF ablation is achieved in 42% of patients after a two-year follow-up. Patients with persistent AF recurrence have a three-fold higher risk of HFH and death."}