Age, Frailty, and Outcomes After Atrial Fibrillation Ablation: A Nationwide Cohort Study

Catheter ablation is a major treatment for atrial fibrillation (AF), but its outcomes in relation to age and frailty are not well understood, especially in an aging population.

A retrospective analysis of the 2016-2021 National Inpatient Sample database identified patients undergoing catheter ablation for AF. Patients were categorized by age and frailty status (low, intermediate, high). Multivariable logistic regression and propensity score matching were used to examine outcomes.

Among 292,395 patients, 79.2% were aged 35-65 years, 15.7% were aged 66-79 years, and 5.1% were aged ≥ 80 years at the time of ablation. The proportion of patients aged ≥ 80 years increased from 11% in 2016% to 21.1% in 2021. Females comprised a higher proportion of the oldest age group (51.4%), but no sex differences were observed across frailty levels. In-hospital mortality was highest in the high frailty group. Patients over 80 years had higher odds of cardiac rhythm restoration and pacemaker implantation but lower risks of cardiogenic shock, mechanical circulatory support, heart failure, myocardial infarction, and major adverse cardiac and cerebrovascular events (MACCE). Higher frailty was associated with an increased risk of in-hospital mortality, complications, and MACCE.

Catheter ablation is increasingly performed in older patients. Advanced age and higher frailty are independently associated with adverse outcomes. These factors should be considered when evaluating patients for this procedure, and strategies to mitigate these risks should be explored.