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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Do Elderly Patients with Atrial Fibrillation Have Comparable Ablation Outcomes Compared to Younger Ones? Evidence
Feng Li1, Lei Zhang1, Li-Da Wu1
1Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi 214023, China.
Insights
Elderly patients undergoing atrial fibrillation (AF) ablation have lower success rates and increased safety risks compared to younger individuals. Follow-up duration appears to influence AF recurrence in older populations.
Area of Science:
- Cardiology
- Electrophysiology
- Geriatric Medicine
Background:
- Age is a recognized independent risk factor for atrial fibrillation (AF) progression and prognosis.
- The comparative outcomes of AF ablation in elderly versus younger patient populations are not well-established.
- Understanding these differences is crucial for optimizing treatment strategies in an aging demographic.
Purpose of the Study:
- To systematically compare the efficacy and safety outcomes of atrial fibrillation ablation between elderly and younger patients.
- To identify potential factors influencing ablation outcomes, particularly in elderly individuals.
Main Methods:
- A comprehensive systematic literature search was conducted across major databases (Cochrane Library, Embase, PubMed, Web of Science) up to April 2022.
- Included studies compared AF ablation outcomes in elderly versus younger patients.
- Meta-analysis with trial sequential analysis (TSA) and subgroup/prediction fit analyses were employed to assess outcomes and identify determinants.
Main Results:
- Analysis of 27 studies involving 113,106 patients revealed elderly patients had a significantly lower rate of freedom from AF (RR, 0.95; p=0.008).
- Elderly patients experienced higher incidences of safety concerns, including cerebrovascular events (RR, 1.64; p=0.000), serious hemorrhage (RR, 1.50; p=0.035), and all-cause death (RR, 2.61; p=0.003).
- Follow-up duration emerged as a potential determinant influencing freedom from AF in elderly patients post-ablation.
Conclusions:
- Elderly patients undergoing AF ablation demonstrate inferior efficacy and safety outcomes compared to their younger counterparts.
- Follow-up time is identified as a critical factor potentially impacting the success of AF ablation in older individuals.
- These findings underscore the need for tailored management strategies for elderly patients with AF undergoing ablation.
Abstract:
Background: Age is an independent risk factor of the progress and prognosis of atrial fibrillation (AF). However, ablation outcomes between elderly and younger patients with AF remain elusive. Methods: Cochrane Library, Embase, PubMed, and Web of Science were systematically searched up to 1 April 2022. Studies comparing AF ablation outcomes between elderly and younger patients and comprising outcomes of AF ablation for elderly patients were included. Trial sequential analysis (TSA) was performed to adjust for random error and lower statistical power in our meta-analysis. Subgroup analysis identified possible determinants of outcome impact for elderly patients after ablation. Moreover, linear and quadratic prediction fit plots with confidence intervals were performed, as appropriate. Results: A total of 27 studies with 113,106 AF patients were eligible. Compared with the younger group, the elderly group was significantly associated with a lower rate of freedom from AF (risk ratio [RR], 0.95; p = 0.008), as well as a higher incidence of safety outcomes (cerebrovascular events: RR, 1.64; p = 0.000; serious hemorrhage complications: RR, 1.50; p = 0.035; all-cause death: RR, 2.61; p = 0.003). Subgroup analysis and quadratic prediction fit analysis revealed the follow-up time was the potential determinant of freedom from AF for elderly patients after AF ablation. Conclusions: Our meta-analysis suggests that elderly patients may have inferior efficacy and safety outcomes to younger patients with AF ablation. Moreover, the follow-up time may be a potential determinant of outcome impact on freedom from AF for elderly patients after AF ablation.
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