Catheter Ablation and Device Therapy in Patients With Transthyretin Amyloid Cardiomyopathy: A Review of Non‐Pharmacological Therapy

In recent years, the number of cases diagnosed with wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) has been increasing. However, ATTRwt-CM frequently coexists with atrial fibrillation (AF), atrial flutter (AFL), and atrial tachycardia (AT), often necessitating management for arrhythmias. Additionally, ventricular arrhythmias sometimes occur, or conduction disturbances often develop, requiring management for bradycardia, frequently needing device therapy such as pacemakers, implantable cardioverter defibrillators (ICDs), or cardiac resynchronization therapy defibrillators. Therefore, for arrhythmia specialists, who primarily focus on non-pharmacological treatments, arrhythmias associated with ATTRwt-CM are unavoidable encounters, and becoming proficient in their management is increasingly important and considered essential. However, we sometimes encounter AF, AFL, or AT that are extremely difficult to treat with catheter ablation, and there are many situations to struggle with: how to manage each arrhythmia and whether catheter ablation should be performed at all. Furthermore, while the usefulness of ICDs for primary prevention of sudden cardiac death remains a subject of debate, we occasionally encounter patients with ventricular arrhythmias in fact. This review primarily addresses and focuses on catheter ablation therapy for atrial arrhythmias associated with ATTRwt-CM, as well as device therapy for bradyarrhythmias and ventricular arrhythmias, aiming to provide insights for treatment planning in the future as a total management approach to arrhythmia in ATTRwt-CM patients, especially for arrhythmia specialists.