Abstract
Atrial fibrillation (AF) is a common and serious arrhythmia that frequently complicates cardiac amyloidosis (CA), a rare condition characterized by amyloid deposits in the heart. The coexistence of AF in CA patients significantly increases the risk of heart failure, stroke, and other life-threatening complications; however, the therapeutic approach to managing AF in CA patients remains underexplored. Thus, this review discusses the features of AF in CA patients, recent research on the development of effective treatment options, and strategies for future therapies. A comprehensive review of the literature was conducted, assessing the epidemiology of AF in CA, the challenges in treatment, and the available intervention strategies, with a particular emphasis on catheter ablation and anticoagulation therapy. AF is highly prevalent in CA patients, with incidence rates reaching 88%. The presence of amyloid deposits exacerbates the risk of arrhythmias, leading to increased morbidity and mortality. Traditional risk stratification models, such as the Congestive Heart Failure, Hypertension, Age ≥75 [Doubled], Diabetes Mellitus, Prior Stroke or Transient Ischemic Attack [Doubled], Vascular Disease, Age 65-74, Female (CHA(2)DS(2)-VASc) score, have limited effectiveness in CA patients. Anticoagulation therapy, particularly direct oral anticoagulants, is recommended to prevent thromboembolic events, though individualized risk assessment is crucial. Catheter ablation has shown promise in improving outcomes, including reducing hospitalization rates and mortality. However, the benefits of catheter ablation remain controversial in light of recent studies suggesting potential risks such as prolonged hospital stays and higher economic burdens. AF is a significant and often fatal complication of CA. The CHA(2)DS(2)-VASc score has limitations in assessing thrombotic risk in CA patients; meanwhile, speckle-tracking echocardiography (STE) has been shown to indirectly predict the danger of thrombosis in these patients. Therefore, the effect of conducting STE on CA patients needs to be further validated. While current therapies, including anticoagulation and catheter ablation, offer some benefits, their effectiveness remains uncertain due to the complexity of the pathophysiology of CA and limited high-quality studies. Future research should focus on developing amyloid-targeted therapies and conducting randomized trials to optimize AF management in CA patients to improve survival and quality of life.