Diagnosis of cardiac amyloidosis in patients undergoing catheter ablation for atrial arrhythmias

Excerpt

Three patients (patient #1: 74-year-old man with paroxysmal atrial fibrillation (AF); patient #2: 82-year-old woman with persistent AF; patient #3: 70-year-old man with persistent typical atrial flutter and left ventricular hypertrophy (LVH)) were referred for catheter ablation. Pre-procedure magnetic resonance imaging (MRI) was performed to define atrial anatomy and to evaluate the left ventricle (LV) given presence of LVH visualized normal LV function with diffuse LV delayed enhancement (DE), increased myocardial native T1 values, and difficulty in nulling of the myocardium in all 3 patients, consistent with cardiac amyloidosis (Fig. 1a, supplemental videos 1 and 2). Patient #3 underwent cavotricuspid isthmus (CTI) ablation and patients #1 and #2 underwent pulmonary vein isolation (PVI) and CTI ablation (patient #2 also underwent empiric posterior wall isolation and lateral mitral annular line for inducible perimitral flutter). Left atrial (LA) mapping showed diffuse bipolar LA voltage abnormalities in patient #2 (Fig. 1b).

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