Catheter ablation for atrial fibrillation in elderly patients: Systematic review and a meta‐analysis

Kawamura, Iwanari; Aikawa, Tadao; Yokoyama, Yujiro; Takagi, Hisato; Kuno, Toshiki

doi:10.1111/pace.14413

Cited by 14 publications

(9 citation statements)

References 40 publications

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“…Moreover, we comprehensively investigated the explanations for primary outcomes, such as use of antiarrhymic agents, impacts of comorbidities, and broader individual complications. Notably, we did not find any significant differences in stroke risks contrasting to the other report 40 . We surmised that the influence of single predominating study , 41 wider‐defined age groups and smaller inherent studies might render the conflicting finding in the previous report .…”

Section: Discussioncontrasting

confidence: 99%

“…While similar conclusion was drawn for AA recurrences, our result disagreed the latter from the previous study. It was highly likely that the previous study was affected by insufficient elderly participants > 75 years old, alluding to an underpower analysis . Subsequently, another meta‐analysis was performed by Kawamura et al , 40 finding no difference in AA recurrence but higher complications rates in elderly patients, in line with our study findings. Despite this similarity, several distinctions should be made aware.…”

Section: Discussioncontrasting

confidence: 99%

“…Notably, we did not find any significant differences in stroke risks contrasting to the other report. 40 We surmised that the influence of single predominating study, 41 wider-defined age groups and smaller inherent studies might render the conflicting finding in the previous report.…”

Section: Comparison With Previous Systematic Review and Meta-analysesmentioning

confidence: 82%

“…Subsequently, another meta‐analysis was performed by Kawamura et al , 40 finding no difference in AA recurrence but higher complications rates in elderly patients, in line with our study findings. Despite this similarity, several distinctions should be made aware.…”

Section: Discussionmentioning

confidence: 99%

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Catheter ablation for atrial fibrillation in the elderly >75 years old: Systematic review and meta‐analysis

Prasitlumkum

Tokavanich

Trongtorsak

et al. 2022

Cardiovasc electrophysiol

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Introduction: Atrial fibrillation (AF) ablation is increasingly performed worldwide. As comfort with AF ablation increases, the procedure is increasingly used in patients that are older and in those with more comorbidities. However, it is not well established whether AF ablation in the elderly, especially those >75 years old, has comparable safety and efficacy to younger populations.Objective: To compare the efficacy and safety profiles in patients older than 75 years undergoing AF ablation with younger patients.Methods: Databases from EMBASE, Medline, PubMed, and Cochrane, were searched from inception through September 2021. Studies that compared the success rates in AF catheter ablation and all complications rates between patients who were older vs under 75 years were included. Effect estimates from the individual studies were extracted and combined using random effect, generic inverse variance method of DerSimonian and Laird.Results: Twenty-seven observational studies were included in the analysis consisting of 363,542 patients who underwent AF ablation. Comparing patients older than 75 years old to younger patients, there was no difference in the success of ablation rates between elderly and younger patients (pooled OR 0.85: 95% CI:0.69-1.05, p = .131). On the other hand, AF ablation in the elderly was associated with higher complication rates (pooled OR 1.42: 95% CI:1.21-1.68, p < .001). Conclusion:As AF ablation is expanded to elderly populations, our study found that AF ablation success rates were similar in both elderly and younger patients. However, older patients experience higher rates of complications that should be considered when offering the procedure and as a means to improve outcomes with future innovations.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 99%

Section: Comparison With Previous Systematic Review and Meta-analysesmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

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Catheter ablation for atrial fibrillation in the elderly >75 years old: Systematic review and meta‐analysis

Prasitlumkum

Tokavanich

Trongtorsak

et al. 2022

Cardiovasc electrophysiol

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“…In this regard, the key to delivering a higher clinical benefit and avoiding pointless procedures in very ill patients may lie in superior patient selection. Some meta-analyses concluded that elderly patients’ long-term catheter ablation for AF effectiveness was equivalent to that of non-elderly patients’, but the incidence of operational complications was higher in elderly patients [ 39 , 40 ]. These findings imply that increased caution and concern for complications should be used when performing invasive cardiac procedures on elderly patients.…”

Section: Discussionmentioning

confidence: 99%

Left Atrial Appendage Closure for Atrial Fibrillation in the Elderly >75 Years Old: A Meta-Analysis of Observational Studies

et al. 2022

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Background: Left atrial appendage closure (LAAC) is an established therapy for patients with atrial fibrillation (AF); however, there is a limited understanding of LAAC in elderly patients (≥75 years old). We conducted a meta-analysis to investigate the procedural complications and long-term outcomes after LAAC in the elderly versus the non-elderly. Methods: We screened PubMed, EMBASE, Cochrane Library, and Web of Science. Procedural endpoints of interest included successful implantation LAAC rates, in-hospital mortality, major bleeding events, pericardial effusion/tamponade, stroke, and vascular access complications related to LAAC. Long-term outcomes included all-cause mortality, major bleeding events, and stroke/transient ischemic attack (TIA) during follow-up. Results: Finally, 12 studies were included in the analysis; these included a total of 25,094 people in the elderly group and 36,035 people in the non-elderly group. The successful implantation LAAC rates did not differ between the groups, while the elderly patients experienced more periprocedural mortality (OR 2.62; 95% CI 1.79–3.83, p < 0.01; I2 = 0%), pericardial effusion/tamponade (OR 1.39; 95% CI: 1.06–1.82, p < 0.01; I2 = 0%), major bleeding events (OR 1.32; 95% CI 1.17–1.48, p < 0.01; I2 = 0%), and vascular access complications (OR 1.34; 95% CI 1.16–1.55, p < 0.01; I2 = 0%) than the non-elderly patients. The long-term stroke/TIA rates did not differ between the elderly and the non-elderly at least one year after follow-up. Conclusions: Even though successful implantation LAAC rates are similar, elderly patients have a significantly higher incidence of periprocedural mortality, major bleeding events, vascular access complications, and pericardial effusion/tamponade after LAAC than non-elderly patients. The stroke/TIA rates did not differ between both groups after at least one-year follow-up.

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Catheter ablation of atrial fibrillation in elderly and very elderly patients: safety, outcomes, and quality of life

Tabaja,

Younis,

Santangeli

et al. 2023

J Interv Card Electrophysiol

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Catheter ablation for atrial fibrillation in elderly patients: Systematic review and a meta‐analysis

Cited by 14 publications

References 40 publications

Catheter ablation for atrial fibrillation in the elderly >75 years old: Systematic review and meta‐analysis

Catheter ablation for atrial fibrillation in the elderly >75 years old: Systematic review and meta‐analysis

Left Atrial Appendage Closure for Atrial Fibrillation in the Elderly >75 Years Old: A Meta-Analysis of Observational Studies

Catheter ablation of atrial fibrillation in elderly and very elderly patients: safety, outcomes, and quality of life

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