Long-term clinical efficacy and risk of catheter ablation for atrial fibrillation in octogenarians

Radiofrequency ablation is an effective treatment for atrial fibrillation (AF). With improved safety, the therapy has been offered to increasingly older populations. Arrhythmia mechanisms, medical comorbidities, and safety may vary in the very elderly population.

Patients presenting for AF ablation were divided into two groups [> or =80 years (n = 35), <80 years (n = 717)]. AF ablation consisted of pulmonary vein antral isolation with or without additional linear lesions. A successful outcome was defined as no further AF and off all antiarrhythmic medications >3 months following 1 + ablation procedures.

The type of AF was similar in both groups (paroxysmal: 46% in the older group vs 54% in the younger, P = 0.33). Older patients were more likely to have a higher CHADS2 score, coronary artery disease, and less likely to have had a prior ablation. The hospital stay on average was longer in the older cohort (2.9 +/- 7.7 vs 2.1 +/- 1.1 days, P = 0.001). There was no increased risk of peri-procedural complications. One-year survival free of AF or flutter was 78% in those >80 and 75% in those younger (P = 0.78). There was no difference between groups if the AF was paroxysmal (P = 0.44) or persistent/chronic (P = 0.74). Over a 3-year follow-up period, five patients died and four strokes occurred all in the younger cohort.

Octogenarian patients, despite more coexistent cardiovascular diseases, have favorable outcomes after AF ablation measured by successful rhythm management. On an average their hospital stay is longer, but no significant increase in short- or long-term complications was observed. These data support AF ablation in select octogenarians.