Ablation of atrial fibrillation after the retirement age: considerations on safety and outcome

Abstract

BACKGROUND: Although the incidence of atrial fibrillation (AF) progressively increases with age, the vast majority of AF ablation is done in middle-aged patients. We evaluated the feasibility and safety of catheter ablation in patients older than 65 years of age with paroxysmal and persistent AF. METHODS: Out of a total of 230 consecutive AF ablation procedures, 45 patients were older than 65 years of age and underwent 53 procedures. The ablation strategy consisted of wide-area circumferential lines around both ipsilateral pulmonary veins using a three-dimensional mapping system. RESULTS: The mean age was 69 ± 3.5 years (35 males). The mean duration for AF was 8.7 ± 6.5 years. Thirty-nine had paroxysmal and six persistent AF despite use of 1.38 ± 0.77 antiarrhythmic drugs. All patients had a structurally normal heart. Eleven had systemic hypertension. Mean procedure time was 187 ± 33 min. Acute procedural success rate with abolition of all pulmonary vein potentials was achieved in all patients. Pericardial tamponade requiring percutaneous drainage occurred in one (1.9%) patient. There were no cardioembolic events. Among the 43 patients whose clinical outcome was assessed at 6 months, 34 (79%) had a significant reduction (>90%) of the total symptomatic AF burden, compared to pre-ablation, with a complete lack of symptomatic AF in 32 (74%) patients. The success rate was higher for patients with paroxysmal versus persistent AF (81 vs. 67%). Six patients (11%) underwent repeat procedures. CONCLUSIONS: Catheter ablation is a safe and effective treatment for patients over the age of 65 years with symptomatic, drug-refractory AF. Therefore, patients should not be excluded from undergoing AF catheter ablation on the basis of age alone.

Catheter ablation for atrial fibrillation in the elderly

“…Recently, our group reported the clinical result of 45 consecutively enrolled patients aged 65 years or more with symptomatic paroxysmal and persistent AF undergoing catheter ablation for rhythm control [23]. Important structural heart disease was not documented in any of these elderly patients.…”

Management of Patients with Atrial Fibrillation: Specific Considerations for the Old Age

“…In a recently published study, we reported the clinical outcome of 45 consecutive patients over the age of 65 years who underwent a percutaneous catheter ablation procedure for symptomatic paroxysmal and persistent AF [57]. Among them, none had a significant structural heart disease.…”

Invasive Management of Atrial Fibrillation and the Elderly

“…10 Oral anticoagulants are highly effective in preventing AF-related stroke, but since the oldest patients are likely to have the highest risk for hemorrhage on warfarin, prescribing anticoagulation is a dilemma that clinicians face, especially for the geriatric population. [7][8] Another matter of contention is the issue of ratecontrol versus rhythm-control. The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial pinned these treatment strategies against each other, only to find no significant difference in mortality.…”

“…Reports assessing ablation for AF in the geriatric population have recently become available. [5][6][7][8] A brief overview of non-ablation invasive management strategies, including pacemakers, defibrillators, and the surgical maze procedure is then included.…”