A clinical and ECG based score to predict incident atrial fibrillation in cardiac amyloidosis: The Amy-Lyon AF score

Introduction Atrial Fibrillation (AF) is the most frequent arrythmia in patients with cardiac amyloidosis (CA) and is poorly tolerated. There is currently no tool to assess the risk of AF occurrence in CA. Objective The aim of the present study was to a clinical and ECG basesd score to predict incident atrial fibrillation in CA. Method We enrolled patients with light chain (AL) or transthyretin (ATTR) CA and no history of AF at diagnosis between January 2015 and September 2023 at 3 university hospitals. Clinical, biochemical and electrocardiographic parameters were retrospectively collected and their predictive value for AF was determined. Results The study included 169 patients [56.2% wild-type (wt) ATTR, 35.5% AL, 8.3% variant (v) ATTR]. Over a median follow-up of 21 months, 55 patients (33%) presented a first episode of AF. Five independent predictors for AF were identified in a multivariate logistic regression model: obesity, hypertension, CA subtype, P wave duration ≥ 120 ms, 1st degree AV block. The Amy-Lyon AF score (range 0-55), based on these variables, predicts the risk of AF occurrence (AUC 0.767 [0.677–0.858], P < 0.001). At two years of follow-up, the incidence of AF was 91.5% in the subgroup of patients with a score ≥ 40 ( Fig. 1 ). Conclusion Our study identifies 5 simple key predictors for risk stratification of AF occurrence in patients with CA. It could be helpfull to define AF screening strategy and anticoagulation therapy.