Atrial fibrillation and atrial flutter were common in patients with wild-type transthyretin cardiac amyloidosis (ATTRwt-CM). Findings were presented at the European Society of Cardiology (ESC) Congress 2025.

This retrospective analysis included 240 patients. At baseline, 158 patients (65.8%) had AF/AFL. The mean age was 80 years, and 86.7% were men. Rhythm control therapy was initiated in 67 patients (42.4%), including electrical cardioversion, pulmonary vein isolation, and amiodarone.

At six months, 44.8% of patients receiving rhythm control were in sinus rhythm. By 12 months, 37.1% remained in sinus rhythm. Amiodarone and pulmonary vein isolation maintained the highest rates, but no strategy consistently outperformed others.

Rhythm control did not significantly affect New York Heart Association class, laboratory biomarkers, or echocardiographic parameters. Baseline differences existed between AF/AFL and sinus rhythm groups for left ventricular ejection fraction, stroke volume, TAPSE, INR, creatinine, eGFR, and NT-proBNP. AF/AFL patients more often received beta-blockers and diuretics.

Rhythm control strategies showed poor long-term effectiveness in ATTRwt-CM. Future studies should evaluate optimal approaches to manage AF/AFL in this population.