Catheter ablation of atrial fibrillation in octogenarians: safety and outcomes

Radiofrequency catheter ablation (RFCA) is an effective treatment for atrial fibrillation (AF), although studies evaluating the role of RFCA have largely excluded elderly patients. We report the safety and outcomes of RFCA of AF in octogenarians.

From 2008 to 2011, out of 2,754 consecutive patients undergoing RFCA of AF, 103 (3.7%) had ≥80 years (age 85 ± 3 years, 4 with >90 years). Pulmonary vein (PV) antrum isolation was performed in paroxysmal AF. In nonparoxysmal AF, ablation was extended to the entire left atrial posterior wall and to complex fractionated electrograms. Non-PV triggers were disclosed by isoproterenol challenge at the end of the procedure and targeted for ablation. Octogenarians presented a high rate of non-PV triggers (84% vs 69%, P = 0.001), especially in patients with paroxysmal AF (62% vs 19%, P < 0.001); non-PV triggers were most commonly mapped in the coronary sinus (54%), left atrial appendage (32%), interatrial septum and superior vena cava (14%). After a mean follow-up of 18 ± 6 months, 71 (69%) octogenarians remained free from AF recurrence off antiarrhythmic drugs after a single procedure (vs 71% in patients <80 years, P = 0.65). The success rate reached 87% after 2 procedures. Total periprocedural complication rates also did not differ between the 2 age groups.

RFCA of AF is safe and effective in octogenarians. A high rate of non-PV triggers is present in these patients, and targeting multiple structures other than the pulmonary veins is often necessary to achieve long-term success.