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Benefits and risks of catheter ablation in elderly patients with atrial fibrillation

Koonlawee Nademanee1, Montawatt Amnueypol1, Frances Lee1

  • 1Pacific Rim Electrophysiology Research Institute at White Memorial Hospital, Los Angeles, California, and Bangkok, Thailand.

Heart Rhythm
|September 27, 2014
PubMed

Insights

Catheter ablation significantly benefits elderly patients with atrial fibrillation (AF), improving survival and reducing stroke risks. This procedure safely maintains normal sinus rhythm (NSR), offering long-term advantages for this population.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Geriatric Medicine

Background:

  • The efficacy of catheter ablation in reducing mortality and stroke in elderly patients with atrial fibrillation (AF) is not well-established.
  • Elderly individuals represent a growing population with AF, necessitating clear evidence on treatment benefits.

Purpose of the Study:

  • To assess the safety and long-term effectiveness of catheter ablation for maintaining normal sinus rhythm (NSR) in elderly patients diagnosed with AF.
  • To evaluate the impact of catheter ablation on survival rates, stroke incidence, and major bleeding events in this demographic.

Main Methods:

  • A cohort of 587 elderly patients (age ≥75 years) with AF was evaluated.
  • 261 patients underwent catheter ablation guided by complex fractionated atrial electrograms (Group 1), while 63 patients did not (Group 2).
  • Key endpoints included sustained NSR, stroke, mortality, and major bleeding events.

Main Results:

  • 83% of patients in Group 1 achieved and maintained NSR compared to 22% in Group 2 over a mean follow-up of 3 years (P <.001).
  • 1- and 5-year survival rates were significantly higher for Group 1 patients in NSR (98% and 87%) versus those in AF (86% and 52%) and Group 2 (97% and 42%).
  • NSR was an independent predictor of survival; older age and reduced ejection fraction were unfavorable. Stroke/bleeding rates were significantly lower in Group 1 patients with NSR (3% over 5 years) compared to Group 2 (16%).

Conclusions:

  • Catheter ablation is a safe and effective procedure for elderly patients with AF, successfully maintaining NSR.
  • The procedure is associated with significant reductions in long-term mortality and stroke risks.
  • AF ablation offers substantial benefits for elderly patients, improving overall survival and quality of life.
Abstract

Keywords:
AblationAnticoagulationAtrial flutterFibrillationStroke

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