Catheter Ablation for Atrial Fibrillation in Cardiac Amyloidosis: A Systematic Review and Meta-Analysis.

BACKGROUND: Atrial fibrillation (AF) is prevalent in cardiac amyloidosis (CA) and is associated with adverse clinical outcomes. Catheter ablation is increasingly used for rhythm control in this population, yet its clinical outcomes remain uncertain. We performed a systematic review and meta-analysis to evaluate arrhythmia recurrence and clinical outcomes following catheter ablation compared with medical therapy in patients with CA. METHODS: We systematically searched MEDLINE, Embase, and Scopus from inception through December 2025 for studies evaluating catheter ablation of atrial arrhythmias in CA. Cohort studies reporting arrhythmia recurrence and/or clinical outcomes were included. The primary outcome was freedom from atrial arrhythmia (AA) following ablation. Secondary outcomes included all-cause mortality, heart failure hospitalization, and stroke. Random-effects models were used to pool event rates and odds ratios (ORs). RESULTS: Thirteen observational studies comprising 797 patients with CA and AF were included. The pooled rate of freedom from AA following catheter ablation was approximately 50% (95% CI 37%-63%; I2 = 71.7%). The all-cause mortality analysis included 4 observational studies comprising 616 patients. Catheter ablation was associated with lower odds of all-cause mortality (OR 0.26, 95% CI 0.11-0.60; I2 = 18.4%); however, this association should be interpreted with caution given the retrospective design and risk of bias. No statistically significant differences were observed for heart failure hospitalization or stroke. CONCLUSIONS: In patients with CA, catheter ablation was associated with modest arrhythmia-free survival and lower odds of all-cause mortality. However, all contributing studies were observational cohorts. Randomized studies are needed to confirm these findings.