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. 2021 Feb 11;11:3563. doi: 10.1038/s41598-021-82554-0

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© The Author(s) 2021

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Interstitial area of atrial appendage myocardium of patients with AF. (a,b) Significant fibrosis and lipomatosis in the interstitium of atrial appendage myocardium. (a) Masson’s trichrome stain. (b) Hematoxylin and eosin. bar 7 µm. (c–e) Isolated atrial amyloidosis in atrial appendage myocardium. Amyloid deposition in the interstitial area on the surface of cardiomyocytes (c) and the wall of the intramural vessel (d). (c,d) Sirius red stain. bar 30 µm. e_1-4—ANP⁺ fibrillar material in the interstitium on the surface of cardiomyocytes sarcolemma and in the walls of blood vessels (arrows). ANP⁺ atrial granules in the sarcoplasm of cardiomyocytes. e₁—ANP/Desmin/DAPI immunohistochemistry. e₂—Desmin-positive fibrils in the sarcoplasm of cardiomyocytes (Alexa 488). e₃—Detection of ANP-positive atrial granules in the sarcoplasm of cardiomyocytes and ANP-positive fibrils in the interstitium (arrows) (Alexa 546). e₄—DAPI-stained nuclei. Immunoconfocal laser microscopy. bar 10 µm. (f,g) Correlation of the amyloid distribution in the LAA (f) and RAA (g) myocardium with the age of patients with AF.