title: Atrial fibrillation in amyloidotic cardiomyopathy: prevalence, incidence, risk factors and prognostic role.
abstract: BACKGROUND
  Although atrial fibrillation (AF) is a known complication of amyloidotic cardiomyopathy (AC), a precise pathophysiological and prognostic characterization is not available. We therefore aimed to assess prevalence, incidence, risk factors and prognostic significance of AF in light-chain (AL), hereditary transthyretin-related (m-ATTR) and non-mutant transthyretin-related (wt-ATTR) AC.
  
  
  METHODS
  Retrospective study of 262 patients with AC (123 AL, 94 m-ATTR, 45 wt-ATTR) from a single center.
  
  
  RESULTS
  AF prevalence was 15% (AL 9%, m-ATTR 11%, wt-ATTR 40%). During a median follow-up of 1.2 years 11 patients developed AF (2.1% person-years). Age, heart failure (HF), left ventricular (LV) ejection fraction, renal involvement, left atrial size and right atrial pressure were independently associated with AF. AF was associated with incident HF but not with increased mortality. All AF patients were prescribed warfarin and none suffered thromboembolic events.
  
  
  CONCLUSIONS
  In AC the prevalence of AF varies widely according to etiology with a mean value of 15% that reaches 40% in wt-ATTR amyloidosis. Age, HF, LV ejection fraction, left atrial size and right atrial pressure were the main independent risk factors, while wall thickness and etiology were not the main independent risk factors. AF does not seem to impact all-cause mortality but was strongly associated with prevalent and incident HF.
authors.affiliation: a Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, Alma Mater Studiorum , University of Bologna , Bologna , Italy .
authors.forename: Simone
authors.initials: S
authors.lastname: Longhi
authors.forename: Candida Cristina
authors.initials: CC
authors.lastname: Quarta
authors.forename: Agnese
authors.initials: A
authors.lastname: Milandri
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Lorenzini
authors.forename: Christian
authors.initials: C
authors.lastname: Gagliardi
authors.forename: Lisa
authors.initials: L
authors.lastname: Manuzzi
authors.forename: Maria Letizia
authors.initials: ML
authors.lastname: Bacchi-Reggiani
authors.forename: Ornella
authors.initials: O
authors.lastname: Leone
authors.forename: Alessandra
authors.initials: A
authors.lastname: Ferlini
authors.forename: Antonio
authors.initials: A
authors.lastname: Russo
authors.forename: Ilaria
authors.initials: I
authors.lastname: Gallelli
authors.forename: Claudio
authors.initials: C
authors.lastname: Rapezzi
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000686:Amyloidosis / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D009202:Cardiomyopathies / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011228:Prealbumin / Q000378:metabolism; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D016019:Survival Analysis; D013923:Thromboembolism / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D016277:Ventricular Function, Left; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D011228:Prealbumin; D014859:Warfarin
keywords: Amyloidosis; atrial fibrillation; cardiomyopathy; heart failure