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

Background Atrial fibrillation (AF) is common and poorly tolerated in cardiac amyloidosis (CA) patients. No current tool assesses AF risk in this population.Methods We enrolled patients with light chain (AL) or transthyretin (ATTR) CA, with no prior history of AF at diagnosis between January 2015 and September 2023 across three university hospitals. Clinical, biochemical and electrocardiographic parameters were retrospectively collected and their predictive value for AF was assessed.Results A total of 169 patients were included (56.2% wild-type (wt) ATTR, 35.5% AL and 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 using multivariate logistic regression model: obstructive sleep apnea, hypertension, CA subtype, P wave duration ≥120 ms, 1st degree atrioventricular (AV) block. Based on these variables, the Amy-Lyon AF score (range 0–46) was developed to estimate AF risk (area under the receiver operating characteristic (ROC) curve (AUC) 0.768 [0.685–0.852], p < .001). At two years of follow-up, the incidence of AF reached 82.7% in patients with a score >28. In 80 patients, the AUC of the Amy-Lyon AF score was higher than that of left atrial strain.Conclusions Five simple and readily available predictors may stratify the risk of AF in CA.