Long-Term Clinical Efficacy and Risk of Catheter Ablation for Atrial Fibrillation in the Elderly

Erica Zado, PAC; David J. Callans, MD; Michael Riley, MD PHD; Mathew Hutchinson, MD; Fermin Garcia, MD; Rupa Bala, MD; David Lin, MD; Joshua Cooper, MD; Ralph Verdino, MD; Andrea M. Russo, MD; Sanjay Dixit, MD; Edward Gerstenfeld, MD; Francis E. Marchlinski, MD

Disclosures

J Cardiovasc Electrophysiol. 2008;19(6):621-626. 

In This Article

Abstract and Introduction

Abstract

Introduction: The number of elderly patients with atrial fibrillation (AF) is increasing rapidly, and the safety and efficacy of catheter ablation in this demographic group has not been established.
Methods: Over a 7-year period we studied 1,165 consecutive patients undergoing 1,506 AF ablation procedures using a consistent ablation protocol that included proximal ostial pulmonary vein (PV) isolation and focal ablation of non-PV AF triggers. Outcome was analyzed for three distinct age groups: <65 years (group 1; n=948 patients), 65–74 years (group 2; n=185 patients), and ≥75 years (group 3; n=32 patients) based on the age at the initial procedure.
Results: There was no significant difference in AF control (89% in group 1, 84% in group 2, and 86% in group 3, P=NS) during a mean follow-up of 27 months. Major complication rates were also comparable (1.6% in group 1, 1.7% in group 2, 2.9% in group 3, P=NS) between the three groups. There was no difference in the left atrial size, percentage with left ventricular ejection fraction <50%, or percentage with paroxysmal versus more persistent forms of atrial fibrillation. However, older patients were more likely to be women (20% in group 1, 34% in group 2, and 56% in group 3, P<0.001) and have hypertension and/or structural heart disease (56% in group 1 vs 68% in group 2 vs 88% in group 3; P<0.001). There was a strong trend demonstrating that older patients were less likely to undergo repeat ablation (26% vs 27% vs 9%) to achieve AF control and more likely to remain on antiarrhythmic drugs (20% vs 29% vs 37%; P<0.05).
Conclusions: Elderly patients with AF undergoing catheter ablation therapy are represented by a higher proportion of women and have a higher incidence of hypertension/structural heart disease. To achieve a similar level of AF control, there appears to be no increased risk from the ablation procedure, but elderly patients are more likely to remain on antiarrhythmic drugs.

Introduction

The incidence of atrial fibrillation (AF) increases with age.[1,2] Ablation for AF, specifically pulmonary vein isolation, has been shown to be effective; however, prior reports have included few elderly patients, and the safety and efficacy of AF ablation has not been adequately assessed in this subset.[3–5] Prior reports on outcome and risk regarding ablation procedures in the elderly did not include complex left atrial procedures.[6–8] Given the relatively increased risk of AF ablation, compared with other ablation procedures and length of the procedure, there is likely to be a reluctance to refer or perform AF ablations in the elderly.[9,10] We sought to gain insight into this important clinical issue by determining whether there was a difference in the clinical characteristics, safety, and efficacy of AF ablation in different age groups in patients undergoing AF ablation procedure.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.

processing....