What clinical parameters or CV imaging considerations would prompt you to consider AV nodal ablation for patients with cardiac amyloidosis and symptomatic atrial fibrillation?

We do this quite often. Atrial fibrillation in amyloidosis often causes considerable clinical deterioration and the first approach should be to attempt to restore sinus rhythm. This can safely be done with electrical cardioversion after adequate anticoagulation. No pre Cardioversion transesophageal echo is needed but an anti arrhythmic agent, ideally amiodarone, needs to be used to prevent recurrence. If the patient fails to maintain sinus rhythm, and is still symptomatic or if there is a clinic...

We prefer left bundle pacing to His bundle pacing these days, given its better performance longterm. We use BiV pacing as a bailout strategy if we cannot achieve a desirable QRS morphology/duration with LB pacing.