Do Elderly Patients with Atrial Fibrillation Have Comparable Ablation Outcomes Compared to Younger Ones? Evidence from Pooled Clinical Studies

Abstract

Background: Age is an independent risk factor of the progress and prognosis of atrial fibrillation (AF). However, ablation outcomes between elderly and younger patients with AF remain elusive. Methods: Cochrane Library, Embase, PubMed, and Web of Science were systematically searched up to 1 April 2022. Studies comparing AF ablation outcomes between elderly and younger patients and comprising outcomes of AF ablation for elderly patients were included. Trial sequential analysis (TSA) was performed to adjust for random error and lower statistical power in our meta-analysis. Subgroup analysis identified possible determinants of outcome impact for elderly patients after ablation. Moreover, linear and quadratic prediction fit plots with confidence intervals were performed, as appropriate. Results: A total of 27 studies with 113,106 AF patients were eligible. Compared with the younger group, the elderly group was significantly associated with a lower rate of freedom from AF (risk ratio [RR], 0.95; p = 0.008), as well as a higher incidence of safety outcomes (cerebrovascular events: RR, 1.64; p = 0.000; serious hemorrhage complications: RR, 1.50; p = 0.035; all-cause death: RR, 2.61; p = 0.003). Subgroup analysis and quadratic prediction fit analysis revealed the follow-up time was the potential determinant of freedom from AF for elderly patients after AF ablation. Conclusions: Our meta-analysis suggests that elderly patients may have inferior efficacy and safety outcomes to younger patients with AF ablation. Moreover, the follow-up time may be a potential determinant of outcome impact on freedom from AF for elderly patients after AF ablation.

Multicenter analysis of atrioesophageal fistula rates before and after adoption of active esophageal cooling during atrial fibrillation ablation

“…[10-13, 69, 70] Moreover, comorbidities such as congestive heart failure, coronary artery disease, lung disease, chronic kidney disease, and age have increased significantly among patients undergoing AF ablation,[5] which may further increase the likelihood of adverse events in the more recently treated population (which includes those in the post-adoption cohort that received esophageal cooling). [7, 71] Operator-specific practice changes, particularly after experiencing an AEF, may alter the risk of a subsequent AEF; however, most sites (64%) in this study had not experienced an AEF before adopting cooling.…”

Safety and efficacy of catheter ablation of atrial fibrillation in the very elderly (≥80 years old): Insights from the UC San Diego AF Ablation Registry

“…14 Although large studies have previously been published on the safety and efficacy of AF in elderly cohorts, the long-term follow-up involving outcomes such as atrial arrhythmia recurrence, hospitalizations, and mortality compared to a younger cohort makes these findings valuable. 15,16 Given a subset of patients remain symptomatic despite rate control, a rhythm control strategy is often pursued, especially since the higher rates of comorbidities present in the elderly population can make the use of AADs challenging. Furthermore, catheter ablation has been shown to be more effective in maintaining sinus rhythm and improving functional status and quality of life in the elderly compared to AADs.…”

“…These findings are significant as AF is the most common arrhythmia in the elderly, with the prevalence expected to increase over the next several decades 14 . Although large studies have previously been published on the safety and efficacy of AF in elderly cohorts, the long‐term follow‐up involving outcomes such as atrial arrhythmia recurrence, hospitalizations, and mortality compared to a younger cohort makes these findings valuable 15,16 …”

“… 14 Although large studies have previously been published on the safety and efficacy of AF in elderly cohorts, the long‐term follow‐up involving outcomes such as atrial arrhythmia recurrence, hospitalizations, and mortality compared to a younger cohort makes these findings valuable. 15 , 16 …”

Atrial Flutter in the Elderly Patient: The Growing Role of Ablation in Treatment

“…The safety of ablation procedures among elderly individuals is increasingly acknowledged [30,31]. However, compared to younger populations, the procedure may carry a relatively less favorable profile of side effects (e.g., cerebrovascular events, bleeding) [32]. There is compelling evidence demonstrating the effectiveness of ablation as a therapeutic intervention.…”