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Efficacy and Safety of Catheter Ablation in Very Elderly Patients With Atrial Fibrillation: Short- To Mid-Term
Takumi Tamura1, Yoshihisa Naruse1, Taro Narumi1
1Internal Medicine III Hamamatsu University School of Medicine Hamamatsu Japan.
Insights
Catheter ablation is effective and safe for very elderly patients with atrial fibrillation (AF). This study found good recurrence-free survival rates and manageable complications in patients aged 80 and over.
Area of Science:
- Cardiology
- Electrophysiology
- Geriatric Medicine
Background:
- Atrial fibrillation (AF) prevalence increases with age.
- Catheter ablation is a standard AF treatment.
- Limited data exists on catheter ablation in patients aged 80+.
Purpose of the Study:
- Assess the efficacy of catheter ablation in very elderly AF patients (≥80 years).
- Evaluate the safety profile of catheter ablation in this demographic.
- Determine complication rates and long-term outcomes.
Main Methods:
- 150 patients aged 80+ underwent catheter ablation for AF (2018-2023).
- Outcomes assessed included AF recurrence, periprocedural complications, and all-cause mortality.
- Follow-up extended to 2 years post-procedure.
Main Results:
- Recurrence-free survival at 2 years was 85.8% for paroxysmal AF and 63.6% for persistent AF.
- 12.0% of patients experienced periprocedural complications, primarily bleeding (6.0%) and heart failure (4.7%).
- No in-hospital deaths, embolisms, or gastroesophageal complications occurred; mortality was unrelated to ablation.
Conclusions:
- Catheter ablation offers reasonable efficacy for very elderly patients with AF.
- The procedure demonstrates an acceptable safety profile in this population.
- Further research can support treatment decisions for older adults with AF.
Background:
Catheter ablation has become a cornerstone of atrial fibrillation (AF) treatment. The prevalence of AF increases with age. However, research on catheter ablation in very elderly patients (age ≥ 80 years) is limited. This study aimed to assess the efficacy and safety of catheter ablation in very elderly patients with AF.
Methods:
We enrolled 150 very elderly patients (mean age, 82.2 ± 2.2 years, 84 men) who underwent catheter ablation for AF in 2018-2023. We assessed AF recurrence, periprocedural complications, and all-cause mortality.
Results:
One hundred (67%) patients had paroxysmal AF, and 136 (90.6%) underwent their first ablation for AF. At 2 years, the recurrence-free survival rate was 85.8% (95% confidence interval [CI], 78.2%-94.2%) in paroxysmal AF and 63.6% (95% CI, 48.9%-82.6%) in persistent AF (p = 0.024). Periprocedural complications occurred in 18 (12.0%) patients. The most common were bleeding events (n = 9; 6.0%), followed by post-ablation heart failure (n = 7; 4.7%). In-hospital death, embolism, gastroesophageal complications, and phrenic nerve paralysis did not occur in any cases. During the median follow-up period of 527 days (interquartile range: 364-913 days), 11 patients (7.3%) died from causes unrelated to the catheter ablation procedures. Periprocedural complications were not associated with an increased risk of all-cause mortality (p = 0.475).
Conclusions:
Catheter ablation demonstrates reasonable efficacy and safety in very elderly patients with AF.
