Benefits and risks of catheter ablation in elderly patients with atrial fibrillation

Abstract

Background: The benefits of catheter ablation for elderly patients with atrial fibrillation (AF) with respect to mortality and stroke reductions remain unclear.

Objective: The purpose of this study was to evaluate the safety and efficacy, including long-term outcomes, of catheter ablation for maintaining normal sinus rhythm (NSR) in elderly patients with AF.

Methods: We evaluated 587 elderly patients (age ≥75 years) with AF. Of the 324 who were eligible for ablation, 261 (group 1) underwent ablation guided by complex fractionated atrial electrogram. The remaining 63 patients (group 2) either declined or were not suitable for ablation. The end-points were NSR, stroke, death, and major bleeding.

Results: Two hundred sixteen patients (83%) remained in NSR compared to only 14 group 2 patients (22%; mean follow-up 3 ± 2.5 years, P <.001). The 1- and 5-year survival rates for group 1 with NSR, group 1 with AF, and group 2 patients were 98% and 87%, 86% and 52%, and 97% and 42%, respectively (P <.0001). NSR was an independent favorable parameter for survival (hazard ratio [HR] 0.36; 95% CI, 0.02-0.63, p = 0.0005), whereas older age (HR 1.09, 95% CI 1.01-1.16, P = .02) and depressed ejection fraction <40% (HR 2.38, 95% CI 1.28-4.4, P = .006) were unfavorable. Warfarin therapy was discontinued in 169 of the 216 group 1 patients (78%) who maintained NSR and had only 3% 5-year stroke/bleeding rates compared to 16% in group 2 (P <.001).

Conclusion: Elderly patients with AF benefit from AF ablation, which is safe and effective in maintaining sinus rhythm and is associated with lower mortality and stroke risks.

Keywords: Ablation; Anticoagulation; Atrial flutter; Fibrillation; Stroke.

Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.