{"id":"2cabf36716d0","type":"article","url":"https://hartvaat.nl/2026/06/30/catheterablatie-verlaagt-sterfte-en-complicaties-bij-af-in-cardiale-amyloidose-t/","title":"Catheterablatie verlaagt sterfte en complicaties bij AF in cardiale amyloïdose — TriNetX-cohort","title_en":"Catheter ablation versus no ablation for atrial fibrillation in cardiac amyloidosis: a propensity-matched cohort study.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Global cardiology science & practice","doi":"10.21542/gcsp.2026.26","source_url":"https://doi.org/10.21542/gcsp.2026.26","authors":["Joud Fahed","Mohammad Hamza","Azka Naeem","Asad Ur Rab","Muhammad Hashim Khan","Mohammad Ali Sheffeh","Jawad Basit","Salem Assiri","M Chadi Alraies"],"significance":5,"published":"2026-08-11","source_date":"2026-06-30","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/icd-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/"],"congress":"","summary_en":"In a propensity-matched cohort of nearly 1,800 patients with cardiac amyloidosis and atrial fibrillation, catheter ablation combined with antiarrhythmic drugs significantly reduced a composite endpoint of all-cause mortality, stroke, bleeding, and myocardial infarction at 12 months compared to medical therapy alone (8.3% vs 13.2%; HR 0.59). Although the ablation group experienced more repeat procedures and device implantations, it also showed a lower mortality rate without differences in new-onset heart failure or hospitalizations. These findings suggest that ablation may be a viable option for carefully selected patients, particularly those with earlier-stage disease or significant symptom burden.","created":"2026-08-05T00:50:38Z","updated":"2026-08-10T10:36:09Z","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 een propensity-gematcht cohort van bijna 1.800 patiënten met cardiale amyloïdose en atriumfibrilleren bleek catheterablatie naast anti-aritmica de kans op een samengestelde uitkomst van sterfte, beroerte, bloedingen en myocardinfarct na 12 maanden significant te verlagen (8,3% versus 13,2%; HR 0,59). Hoewel de ablatiegroep vaker herhalende ingrepen of pacemaker-/ICD-implantaties nodig had, werd ook de all-cause sterfte gereduceerd zonder verschil in nieuwe hartfalen-episodes of ziekenhuisopnames. Voor zorgprofessionals betekent dit dat ablatie overwogen kan worden bij zorgvuldig geselecteerde patiënten, met name in vroeger stadium of bij duidelijke symptomen.","abstract_original":"BACKGROUND: Atrial fibrillation (AF) is extremely common in cardiac amyloidosis (CA) due to amyloid infiltration and atrial electrical remodeling. We aim to compare ablation outcomes versus no-ablation in patients taking anti-arrhythmic drugs (AAD) in CA-associated AF. METHODS: Using TriNetX database (2019-2025), 5,562 patients with CA and AF were identified and divided into two groups: catheter ablation plus AADs (n = 893) versus medical therapy alone (n = 4,669). Baseline characteristics were adjusted and 1:1 propensity score matching was performed to account for baseline differences. Primary composite outcome included all-cause mortality, ischemic strokes, bleeding and subsequent myocardial infarction. RESULTS: 870 patients were included in each cohort. At 12-month follow-up, catheter ablation was associated with a significantly lower risk of the composite outcome (8.3% vs 13.2%; HR 0.591, 95% CI [0.418-0.834], p = 0.002), and reduced all-cause mortality. There were no significant differences in all-cause hospitalization, emergency department visits, new-onset heart failure, atrioventricular block, or cardiac arrest. Repeat ablation or cardioversion, and subsequent pacemaker or ICD implantation were more frequent in the ablation group. CONCLUSION: Catheter ablation was associated with improved short-term outcomes despite higher arrhythmia recurrence. Ablation may be considered in carefully selected patients, particularly those with earlier-stage disease or significant symptoms."}