Catheter Ablation for Atrial Fibrillation in Elderly Patients: an Updated Meta-analysis of Comparative Studies

Age is a relevant risk factor for the development of atrial fibrillation (AF) and is associated with increased recurrence rates in the setting of rhythm control. Catheter ablation is increasingly advocated in elderly despite conflicting data regarding its efficacy and safety in this patient cohort. Therefore, we aimed to analyse currently available evidence regarding catheter ablation for AF in patients ≥ 75 years old compared with younger patients.

We performed a systematic literature search and meta-analysis on efficacy and safety of catheter ablation in patients ≥ 75 years old with AF. Primary efficacy and safety end points were first recurrence of atrial arrhythmia after first-time ablation and occurrence of death, stroke, or any procedure-related complication. Secondary outcomes included procedure and fluoroscopy time.

We identified 301 potentially relevant studies, of which 39 underwent detailed analysis. A total of 19 studies (MINORS score ≥ 13) reporting on 108,419 patients (101,844 < 75 years, 6,575 ≥ 75 years of age) undergoing first-time catheter ablation for AF were included. Risk of arrhythmia recurrence after catheter ablation (39% vs 32%, relative risk [RR] 1.24, 95% confidence interval [CI] 1.09-1.41; P = 0.001) and occurrence of safety end points (10.8% vs 8.5%; RR 1.64, 95% CI 1.53-1.76; P < 0.00001) were significantly higher in patients ≥ 75 years of age than in younger patients. There was no difference concerning procedure (P = 0.33) or fluoroscopy time (P = 0.91) between younger and elderly patients.

In patients ≥ 75 years of age, catheter ablation for AF has higher risk of arrhythmia recurrence and is associated with an increased risk of procedure-related complications and safety end point occurrence compared with younger patients.