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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

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Catheter Ablation in Older Patients with Atrial Fibrillation

Tadashi Yamamoto1,2, Takuya Kishi1,2, Ayako Takamori3

  • 1International University of Health and Welfare Graduate School of Medicine.

International Heart Journal
|February 2, 2025
PubMed

Insights

Catheter ablation for atrial fibrillation (AF) is safe and effective in late old-aged patients (≥75 years), showing similar success and complication rates compared to younger groups. This procedure improves cardiac function and reduces natriuretic peptide levels, even in the oldest individuals.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Geriatric Medicine

Background:

  • Atrial fibrillation (AF) prevalence increases with age, and catheter ablation is a common treatment.
  • Older patients may experience lower success rates and higher complication risks with AF ablation.
  • Age-related differences in AF ablation outcomes require further investigation.

Purpose of the Study:

  • To compare the characteristics, success rates, and complications of catheter ablation in middle-aged, early old-aged (65-74 years), and late old-aged (≥75 years) patients with AF.
  • To evaluate the effects of catheter ablation on cardiac function (left ventricle and left atrium) and plasma B-type natriuretic peptide levels in different age groups.

Main Methods:

  • Retrospective comparison of AF patients undergoing catheter ablation, categorized into three age groups: middle-aged (<65 years), early old-aged (65-74 years), and late old-aged (≥75 years).
  • Assessment of procedural success, recurrence rates, and complications.
  • Evaluation of left ventricular ejection fraction, left atrial volume index, left atrial emptying fraction, and plasma B-type natriuretic peptide levels at baseline and 1 year post-ablation.

Main Results:

  • AF ablation was successfully performed across all age groups, with no statistically significant differences in recurrence rates (late old-aged: 29.7%, early old-aged: 15.5%, middle-aged: 23.1%).
  • Procedural complication rates were similar among the groups (late old-aged: 9.5%, early old-aged: 6.2%, middle-aged: 3.3%).
  • Late old-aged patients had a greater left atrial volume index and more comorbidities (hypertension, heart failure, stroke). At 1 year, improvements in left ventricular ejection fraction, left atrial volume index, and left atrial emptying fraction were observed in all groups, including the late old-aged. Plasma B-type natriuretic peptide levels decreased in both older groups.

Conclusions:

  • Catheter ablation for atrial fibrillation is effective and safe in late old-aged patients (≥75 years).
  • The procedure demonstrates significant improvements in cardiac structure and function, even in the oldest patient cohort.
  • Complication rates are comparable to those in middle-aged patients, supporting its use in elderly individuals.

Keywords:
AgingArrhythmiaHeart failureLeft atriumNatriuretic peptidePulmonary vein

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