Catheter Ablation of Atrial Arrhythmias in Cardiac Amyloidosis: A Systematic Review and Meta-Analysis

Catheter Ablation of Atrial Arrhythmias in Cardiac Amyloidosis: A Systematic Review and Meta-Analysis | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 30 August 2025 V1 Latest version Share on Catheter Ablation of Atrial Arrhythmias in Cardiac Amyloidosis: A Systematic Review and Meta-Analysis Authors : Lorenzo Olivero 0000-0003-2358-9527 [email protected] , Diana Jaen , Jorge Sinclair , Santiago Saez-Ancira , Antony Gonzales-Uribe , Sridhar Mangalesh , Panagiotis Theodoropoulos , Adam Gershon , Robert Faillace , and Michael Grushko Authors Info & Affiliations https://doi.org/10.22541/au.175658237.76914686/v1 375 views 140 downloads Contents Abstract INTRODUCTION Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Introduction Atrial arrhythmias (AA) are common in cardiac amyloidosis and are strongly associated with increased morbidity, heart failure hospitalizations, and thromboembolic events. Catheter ablation is increasingly performed, but its efficacy and safety in this population remain unclear. Methodology A systematic review and meta-analysis were conducted, including studies of adults with cardiac amyloidosis undergoing catheter ablation. Data extracted included baseline characteristics, arrhythmia type, ablation modality, and follow-up duration. In the single-arm analysis, outcomes were recurrence of atrial arrhythmias and time to recurrence. For the comparative analysis, outcomes were heart failure hospitalization and all-cause mortality. Pooled incidence rates were calculated per 100 person-years for single-arm studies, while comparative studies (ablation vs. no ablation) were analyzed using random-effects models to generate risk ratios (RR) and hazard ratios (HR) with 95% confidence intervals. Results Ten studies (233 patients, 91% ATTR-CM) were included. The pooled arrhythmia recurrence rate was 35.1 per 100 person-years (95% CI: 19.4-63.3), with a mean time to recurrence of 12 months (95% CI: 5.4-18.6). In comparative analyses (3 studies, 286 patients), catheter ablation significantly reduced heart failure hospitalizations (RR 0.44, 95% CI: 0.38-0.51) and all-cause mortality (HR 0.42, 95% CI: 0.24-0.73). Conclusion Catheter ablation in cardiac amyloidosis is associated with moderate recurrence rates but marked reductions in HF hospitalization and mortality, particularly in early disease stages. These findings support ablation as a valuable rhythm control strategy, though prospective trials are needed to confirm its role. Catheter Ablation of Atrial Arrhythmias in Cardiac Amyloidosis: A Systematic Review and Meta-Analysis AUTHORS Olivero, Lorenzo, M.D., 1 Jaen, Diana, M.D., 2 Sinclair, Jorge, M.D., 3 Saez-Ancira, Santiago, M.D., 1 Gonzales, Anthony, M.D., 1 Mangalesh, Sridhar, M.B.B.S., 1 Theodoropoulos, Panagiotis, M.D., 1 Gershon, Adam, M.D., 4 Faillace, Robert, M.D., 1,4 Grushko, Michael, M.D. 4,5 AFFILIATIONS 1. Department of Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA 2. University of Nebraska Medical Center, NE, USA 3. Department of Medicine, Mount Sinai Morningside and West, New York, NY, USA 4. Division of Cardiology, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA 5. Director of Arrhythmia and Electrophysiology, Division of Cardiology, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA CORRESPONDING AUTHOR Lorenzo Olivero, MD Department of Medicine Jacobi Medical Center 1400 Pelham Parkway S, NY 10461, USA E-mail: [email protected] Tel: (718) 918-5642 Introduction Atrial arrhythmias (AA) are common in cardiac amyloidosis and are strongly associated with increased morbidity, heart failure hospitalizations, and thromboembolic events. Catheter ablation is increasingly performed, but its efficacy and safety in this population remain unclear. Methodology A systematic review and meta-analysis were conducted, including studies of adults with cardiac amyloidosis undergoing catheter ablation. Data extracted included baseline characteristics, arrhythmia type, ablation modality, and follow-up duration. In the single-arm analysis, outcomes were recurrence of atrial arrhythmias and time to recurrence. For the comparative analysis, outcomes were heart failure hospitalization and all-cause mortality. Pooled incidence rates were calculated per 100 person-years for single-arm studies, while comparative studies (ablation vs. no ablation) were analyzed using random-effects models to generate risk ratios (RR) and hazard ratios (HR) with 95% confidence intervals. Results Ten studies (233 patients, 91% ATTR-CM) were included. The pooled arrhythmia recurrence rate was 35.1 per 100 person-years (95% CI: 19.4-63.3), with a mean time to recurrence of 12 months (95% CI: 5.4-18.6). In comparative analyses (3 studies, 286 patients), catheter ablation significantly reduced heart failure hospitalizations (RR 0.44, 95% CI: 0.38-0.51) and all-cause mortality (HR 0.42, 95% CI: 0.24-0.73). Conclusion Catheter ablation in cardiac amyloidosis is associated with moderate recurrence rates but marked reductions in HF hospitalization and mortality, particularly in early disease stages. These findings support ablation as a valuable rhythm control strategy, though prospective trials are needed to confirm its role. INTRODUCTION Atrial arrhythmias (AA) are highly prevalent in patients with cardiac amyloidosis, affecting up to 70% of those with transthyretin amyloid cardiomyopathy (ATTR-CM), and are strongly associated with increased morbidity, heart failure (HF) hospitalizations, and thromboembolic events. 1,2 The atrial substrate in amyloidosis, marked by fibrosis, conduction issues, and structural remodeling from amyloid fibril infiltration, makes AAs management particularly challenging. 3,4 Rate-controlling agents are often poorly tolerated in patients with cardiac amyloidosis, with discontinuation rates reported as high as 80%. 3–5 This intolerance is largely due to the underlying restrictive physiology and fixed, low stroke volume, which make cardiac output highly dependent on heart rate. As a result, rate-control agents can lead to symptomatic hypotension and worsening HF. Alternatively, rhythm control strategies such as direct current cardioversion (DCCV) and amiodarone are commonly utilized; however, these approaches are associated with high recurrence rates, exceeding 90% in some cohorts, and have not demonstrated a significant improvement in arrhythmia-free survival. 6,7 Catheter ablation has emerged as another rhythm control option, but its utility in this population is not well defined. The extent to which atrial amyloid infiltration influences procedural outcomes and arrhythmia recurrence remains unclear, raising the question of whether patients with cardiac amyloidosis experience higher recurrence rates after ablation. While small studies have suggested that sinus rhythm maintenance may confer clinical benefit particularly in early disease, procedural success is often hindered in advanced stages. This review summarizes evidence on catheter ablation for AAs in cardiac amyloidosis, assessing recurrence rates, time to recurrence, HF hospitalizations, and mortality to clarify its clinical role in this high-risk group. 2. METHODS The present systematic review and meta‐analysis were performed in accordance with PRISMA guidelines. 8 The prospective meta‐analysis protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO; CRD420251055226). 2.1. Research question In patients with cardiac amyloidosis, what is the recurrence rate of AAs after catheter ablation? Compared to not receiving ablation, how does catheter ablation impact HF hospitalization and mortality rates? 2.2. Eligibility criteria Studies were considered eligible for inclusion if they met the following criteria: 1) cohort studies, case-control studies, or clinical trials, either randomized or non-randomized; 2) inclusion of patients with any form of cardiac amyloidosis, including wild-type transthyretin (ATTRwt), hereditary transthyretin (ATTRv), or light-chain (AL) amyloidosis; 3) presence of AA, including atrial fibrillation (AF), atrial flutter (AFL), or atrial tachycardia (AT); and 4) use of catheter ablation employing any energy source, including radiofrequency (RF), cryoablation, or pulsed field ablation (PFA). Studies were excluded if they were non-human, abstracts, conference posters, case reports, reviews, and editorials. In addition, nationwide databases were excluded due to potential risk of patient duplication and limited granularity of procedural and clinical outcome data. 2.3. Search strategy We screened PubMed, Embase, Web of Science and Cochrane databases from the inceptions to 5 May 2025, using the following search terms: (”atrial fibrillation” OR ”auricular fibrillation” OR ”AF” OR ”AFib” OR ”atrial arrhythmia”) AND (cardiac amyloidosis OR amyloid*) AND (ablation OR PVI OR “pulmonary vein isolation” OR cryoballoon OR cryotherapy OR cryothermal OR cryoenergy OR cryoablation OR contact force OR radiofrequency) 2.3. Study selection and data extraction All identified studies were de-duplicated and independently screened by title and abstract by three authors (L.O., D.J., J.S.) using Covidence. 9 Any discrepancies were resolved through discussion among authors. Studies deemed potentially eligible underwent full-text review for final inclusion. For studies deemed eligible, the following data was extracted, including study design, follow-up duration, type of AA, ablation energy used, cardiac amyloidosis diagnosis criteria, and outcomes. Data was extracted from text, tables, figures, and supplementary material. 2.4. Statistical analysis and quality assessment For the single-arm meta-analysis of atrial arrhythmia recurrence, recurrence rates were calculated per 100 person-years to account for varying follow-up durations across studies. When available, we also pooled the mean time to arrythmia recurrence. Pooled estimates were reported as incidence rates per 100 person-years and means, each with corresponding 95% confidence intervals. Eligible studies reporting comparative clinical outcomes by treatment group (ablation vs. no ablation) were included in the two-arm meta-analyses. Effect sizes for comparative outcomes were reported as risk ratios (RRs) and hazard ratios (HRs), each with corresponding 95% confidence intervals. All analyses were performed using RStudio (v4.5.0) and Review Manager (RevMan) version 9.3.0, applying a random-effects model with the DerSimonian-Laird method. The risk of bias for included non-randomized studies was assessed using the ROBINS-I tool 10 across seven domains: confounding, selection of participants, classification of interventions, deviations from intended interventions, missing data, outcome measurement, and selective reporting. 3. RESULTS Figure 1 illustrates the PRISMA flow diagram for the study selection process. A total of 376 records were identified through database and citation searches. After removing 95 duplicates, 281 records were screened, with 257 excluded based on title and abstract. Full-text review was conducted on 22 studies, of which 12 were excluded. Notably, three studies utilizing national databases were excluded due to concerns regarding potential patient duplication and methodological limitations inherent to administrative data. Finally, 10 studies were included in the final systematic review and meta-analysis. 3.1. Single-arm analysis Baseline characteristics A total of 10 retrospective cohort studies were included, 1,5,11–18 as shown in Table 1, encompassing 233 patients with cardiac amyloidosis who underwent catheter ablation for atrial arrhythmias. Most patients (91%) had ATTR-CM. Radiofrequency energy was the most used ablation modality, reported in 6/10 studies; two studies utilized both radiofrequency and cryoablation, while two did not disclose the energy source. Half of the included studies (5/10) explicitly reported atrial arrhythmia recurrence following a 3-month blanking period; the remaining studies did not specify a blanking period. The mean follow-up duration across all studies was 21.7 months. When AF and AFL outcomes were reported separately, only AF data were extracted to ensure consistency across studies since AFL outcomes were too sparsely reported for meaningful analysis. 5 In studies reporting outcomes after multiple ablation procedures, data were limited to the first ablation. 19 Recurrence Outcomes Ten studies were included in the single arm analysis as shown in Figure 2 , encompassing 233 patients and 141 recurrence events. The pooled recurrence rate was 35.1 per 100 person-years (95% CI: 19.4 - 63.3, I 2 =89.4%). Out of five studies reporting mean time to arrhythmia recurrence following catheter ablation yielded a pooled mean of 12.0 months (95% CI: 5.4 - 18.6, I² = 22.5%) using a random-effects model. 3.2. Comparative analysis Three studies (Donellan 2020, Kanazawa 2024, and Yakabe 2025) comprising a total of 286 patients evaluating the impact of catheter ablation on all-cause mortality and HF hospitalization in patients with atrial arrhythmias and ATTR-CM were included. Median follow-up across included studies was 46.2 months. Table 2 summarizes baseline characteristics of the included studies. Within each study, demographics such as age and sex were generally similar between groups. In Donnellan 2020, persistent AF was notably more prevalent in the ablation group (83% vs 46%). When comparing trends across studies, there were no consistent differences in medication use or comorbidities such as diabetes and coronary artery disease. Heart Failure Hospitalization HF hospitalizations were significantly lower in the ablation group compared to the no ablation group, with a risk ratio (RR) of 0.44 (95% CI: 0.38–0.51; p < 0.001), indicating a 56% relative reduction in HF hospitalization rates in this population. No statistical heterogeneity was observed (I² = 0%, τ² = 0, p = 0.9421). Mortality The pooled hazard ratio (HR) for mortality was 0.42 (95% CI: 0.24–0.73; p = 0.002), indicating a 58% relative reduction in the risk of death in the ablation group compared to the no ablation group. Between-study heterogeneity was minimal (I² = 0%, τ² = 0), suggesting consistent findings across studies. Risk of bias assessment Risk of bias was judged moderate to serious across all studies, mainly due to confounding and selection inherent to retrospective, non-randomized designs. Intervention classification and adherence were consistently low risk, while missing data and outcome assessment raised moderate concerns. Larger multicenter cohorts, such as Yakabe 2025 and Miyamoto 2023, showed relatively lower bias but residual concerns remained ( Table 4 ). 4. DISCUSSION The present systematic review and meta-analysis represents the most comprehensive synthesis to date of catheter ablation outcomes for atrial arrhythmias in patients with cardiac amyloidosis. Our analysis focused primarily on ATTR-CM, which accounted for 91% of the pooled cohort (n = 233), and included all major amyloid subtypes and ablation energy sources. The pooled incidence rate of atrial arrhythmia recurrence following catheter ablation was 35.1 events per 100 person-years (95% CI: 19.4–63.3), with a mean time to recurrence of 12 months (95% CI: 5.4–18.6) over a mean follow-up of 21.7 months. These findings highlight a moderate arrhythmia recurrence. Recurrence Rate When contextualized against non-amyloid populations, our results suggest that recurrence rates following ablation in cardiac amyloidosis are comparable to or slightly higher than those previously reported. For example, pooled analysis of randomized controlled trials in non-amyloid patients with paroxysmal AF have shown a 1-year arrhythmia-free survival rate of 72.8%, corresponding to a 27.2% recurrence rate. 20 In contrast, the German Ablation Registry reported a higher 1-year recurrence rate of 45.9% among 3,703 patients. 4 Our observed rate of 35.1 per 100 person-years and CI falls between the previous rates, suggesting comparable outcomes between amyloidosis and non-amyloid population. This result is consistent regardless of the type of AF in the previous literature. Recurrence rate from paroxysmal AF ranged from 25% in the AWARE trial, 21 to 45.9% in a meta-analysis after single ablation. 22 For persistent AF, the STAR AF II trial showed a 41% recurrence rate of AF within 1 year after pulmonary vein isolation. Similarly, pooled recurrence rate from a meta-analysis found a 39% recurrence rate persistent AF and a 33% recurrence rate for paroxysmal AF. 23 Furthermore, emerging comparative data suggest that atrial arrhythmia recurrence after catheter ablation may be more pronounced in cardiac amyloidosis than in other infiltrative cardiomyopathies. In a recent propensity-matched cohort study, 24 patients with cardiac amyloidosis had significantly higher recurrence rates compared to matched controls (47.4% vs. 27.1%; P = 0.049), whereas no such difference was observed in cardiac sarcoidosis (33.3% vs. 33.9%; P = 0.965). Although no direct comparisons exist between ATTR-CM and hypertrophic cardiomyopathy (HCM), prior meta-analyses have shown wide variability in post-ablation outcomes among patients with HCM, with reported recurrence rates ranging from 18 to 52.5%. 25 Clinical Outcomes: Heart Failure Hospitalization and Mortality Despite this relatively moderate-high recurrence rate, ablation was associated with a 56% reduction in HF hospitalizations and a 58% reduction in all-cause mortality when compared to non-ablation cohorts. The most clinically significant findings relate to the impact of ablation on HF hospitalization and all-cause mortality. This meta-analysis found a 56% relative reduction in HF hospitalization (RR 0.44, 95% CI: 0.38–0.51) and a 58% relative reduction in mortality (HR 0.42, 95% CI: 0.24–0.73) for ablation versus no ablation, with minimal inter-study heterogeneity. These benefits are most pronounced in early-stage ATTR-CM and are closely linked to successful maintenance of sinus rhythm post-ablation. 1,11 Maury et al. observed that maintenance of sinus rhythm after ablation was associated with improvements in NYHA class, reductions in natriuretic peptide levels, and lower rates of HF-related death. 16 These findings are consistent with the broader literature, which demonstrates that ablation in non-amyloid HF cohorts also reduces HF hospitalizations and improves survival, but the absolute benefit may be greater in amyloidosis due to the high baseline risk and limited efficacy of medical therapy. 26,27 Mechanistic Insights: Atrial Arrythmia Complexity in Amyloidosis The elevated recurrence rates and procedural challenges in cardiac amyloidosis are mechanistically explained by the diffuse infiltration of amyloid fibrils within the atrial myocardium and conduction system. This results in extensive low-voltage areas, atrial dilation (as shown in Table 2 ), and a high prevalence of non-pulmonary vein (PV) triggers and macro-reentrant AFLs. For example, non-PV triggers were identified in 29.2% of amyloidosis patients compared to 8.3% of controls, and left atrial macro-reentrant flutters in 37.5% versus 6.3%. 24 Barbhaiya et al. further demonstrated that amyloidosis patients had more extensive left atrial low-voltage areas (63% vs. 34%) and a greater number of inducible atrial tachycardias (mean 3.3 vs. 0.2 per patient) compared to non-amyloid controls. 13 These findings underscore the need for individualized, often more extensive ablation strategies, including adjunctive lesion sets and comprehensive mapping, rather than standard PV isolation alone. Impact of Amyloid Subtype and Disease Stage on Catheter Ablation Outcomes The benefit of ablation is most pronounced in in early-stage disease. Kanazawa et al. reported a 1-year recurrence-free rate of 70.1% and a 5-year rate of 44.0% in ATTRwt-CM, with significant reductions in all-cause mortality (HR: 0.342), cardiovascular mortality (HR: 0.378), and HF hospitalization (HR: 0.488) compared to non-ablated controls. 19 Donnellan et al. found that ablation was significantly more effective in stage I/II ATTR-CM (64% recurrence-free) than in stage III (10% recurrence-free), and was associated with a 62% reduction in mortality (HR: 0.38) and a significant reduction in HF/arrhythmia hospitalizations (mean 1.7 vs. 4.0, P = 0.005). 1 Yakabe et al. corroborated these findings, showing that ablation was most effective in stage I disease, with maintenance of sinus rhythm conferring the greatest clinical benefit (HR for composite endpoint: 0.17). 11 The representation of AL cardiac amyloidosis in ablation studies remains limited, reflecting both its lower prevalence and the more advanced stage at which patients typically present. In the cohort studied by Maury et al., 16 there were no significant differences in atrial arrhythmia recurrence, mortality, or heart failure hospitalizations between patients with ATTR and AL cardiac amyloidosis. Both subtypes experienced moderate rates of arrhythmia recurrence following catheter ablation and similar overall clinical outcomes. However, in the ablation cohort reported by Tan et al., 18 three deaths were observed, all in patients with AL cardiac amyloidosis, likely reflecting the rapid disease progression characteristic of AL, rather than arrhythmia recurrence alone. While both subtypes appear to benefit from sinus rhythm maintenance, the extent of clinical benefit remains limited and underexplored in the current literature. Safety Outcomes and Procedural Risk Procedural safety in cardiac amyloidosis is a critical concern due to the increased risk of conduction system disease, periprocedural complications, and the potential for worsening HF. However, the available data suggest that, when performed in experienced centers and with appropriate patient selection, catheter ablation can be performed with acceptable safety profiles. Major complications are infrequent, and short-term safety outcomes are similar to those in matched patients with dilated cardiomyopathy. 28 The risk of complications may be higher in patients with advanced disease or significant comorbidities, underscoring the importance of individualized risk assessment and multidisciplinary care. Limitations Despite the strengths of the current meta-analysis, several limitations must be acknowledged. Most included studies are retrospective and observational, with inherent risks of selection bias and confounding. The majority of patients had ATTR-CM, and the representation of AL amyloidosis and other rare subtypes remains limited. Procedural details, such as mapping strategies, lesion sets, and periprocedural management, were inconsistently reported, and variable definitions varied across studies. Pooled analysis was performed from a combined cohort of AF, AFL, and AT, which have distinct anatomical triggers and procedural approaches. Further subgroup analysis is necessary to clarify this distinction. Furthermore, cause of mortality was rarely specified, limiting interpretation of the observed survival benefit. Data on repeat ablation procedures were limited, and long-term outcomes beyond 2-3 years are sparse. Safety outcomes were not consistently reported, and the impact of advanced conduction disease and periprocedural HF exacerbation may be underappreciated. Future directions There is a critical need for prospective, multicenter RCTs in patients with cardiac amyloidosis to better define the efficacy and safety of catheter ablation across different arrhythmia types and amyloid subtypes. Specifically, comparative studies evaluating various ablation modalities are essential to optimize procedural outcomes and tailor treatment strategies to the unique atrial substrate seen in amyloidosis. Additionally, optimal patient selection and timing of ablation remain poorly defined, particularly in the context of progressive myocardial involvement and variable disease stage. Studies are also needed to explore subtype-specific outcomes, long-term arrhythmia-free survival, and quality-of-life benefits. As new disease-modifying therapies emerge, such as Tafamidis, Patisiran, and Acoramidis, among others, it remains uncertain how they will affect rhythm control strategies. By stabilizing or slowing disease progression, such therapies could potentially enhance the durability of sinus rhythm post-ablation or modify atrial remodeling, thus improving procedural success rates. Future research should investigate the synergistic role of rhythm control and disease-modifying agents in the holistic management of cardiac amyloidosis. Importantly, while the American College of Cardiology and American Heart Association recommend indefinite anticoagulation for all patients with AF or flutter regardless of CHA₂DS₂-VASc score due to elevated thromboembolic risk, the optimal anticoagulation strategy following catheter ablation remains unclear. Given the recurrence rate in this population, future research should aim to clarify the duration, intensity, and choice of anticoagulation, balancing stroke prevention with bleeding risk in this cohort. 5. CONCLUSION Collectively, these findings suggest that catheter ablation should be considered a viable rhythm control strategy for patients with atrial arrhythmias and cardiac amyloidosis, similar to its role in the non-amyloid population. In patients with ATTR-CM, ablation has been associated with reductions in HF hospitalizations and all-cause mortality. Procedural safety appears acceptable in experienced centers; however, the greatest benefit is observed in those with less advanced amyloid infiltration, likely due to the more complex arrhythmogenic substrate in advanced disease. Therefore, the choice of ablation modality should be individualized based on patient characteristics and disease severity. REFERENCES 1. Donnellan E, Wazni O, Kanj M, et al. Atrial fibrillation ablation in patients with transthyretin cardiac amyloidosis. Europace . 2020;22(2):259-264. doi:10.1093/europace/euz3142. Mistrulli R, Ferrera A, Muthukkattil ML, et al. Atrial Fibrillation in Patients with Hypertrophic Cardiomyopathy and Cardiac Amyloidosis: From Clinical Management to Catheter Ablation Indication. J Clin Med . 2024;13(2). doi:10.3390/jcm130205013. 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Keywords basic: atrial fibrillation/atrial arrhythmias clinical: catheter ablation – atrial fibrillation clinical: catheter ablation – atrial flutter clinical: electrophysiology – atrial arrhythmias Authors Affiliations Lorenzo Olivero 0000-0003-2358-9527 [email protected] New York City Health and Hospitals Jacobi View all articles by this author Diana Jaen University of Nebraska Omaha View all articles by this author Jorge Sinclair Mount Sinai Morningside Hospital View all articles by this author Santiago Saez-Ancira New York City Health and Hospitals Jacobi View all articles by this author Antony Gonzales-Uribe New York City Health and Hospitals Jacobi View all articles by this author Sridhar Mangalesh New York City Health and Hospitals Jacobi View all articles by this author Panagiotis Theodoropoulos New York City Health and Hospitals Jacobi View all articles by this author Adam Gershon New York City Health and Hospitals Jacobi View all articles by this author Robert Faillace New York City Health and Hospitals Jacobi View all articles by this author Michael Grushko New York City Health and Hospitals Jacobi View all articles by this author Metrics & Citations Metrics Article Usage 375 views 140 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Lorenzo Olivero, Diana Jaen, Jorge Sinclair, et al. Catheter Ablation of Atrial Arrhythmias in Cardiac Amyloidosis: A Systematic Review and Meta-Analysis. Authorea . 30 August 2025. DOI: https://doi.org/10.22541/au.175658237.76914686/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . 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