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

Abstract

BackgroundCatheter ablation improves outcomes in symptomatic atrial fibrillation (AF) patients. However, its safety and efficacy in the very elderly (≥80 years old) is not well described.HypothesisAblation of AF in the very elderly is safe and effective.MethodsWe performed a retrospective study of all patients who underwent catheter ablation enrolled in the University of California, San Diego AF Ablation Registry. The primary outcome was freedom from atrial arrhythmias on or off antiarrhythmic drugs (AADs).ResultsOf 847 patients, 42 (5.0%) were 80 years of age or greater with a median age of 81.5 (80–82.3) and 805 (95.0%) were less than 80 years of age with a median age of 64.4 (57.6–70.2). Among those who were ≥80 years old, 29 were undergoing de novo ablation (69.0%), whereas in the younger cohort, 518 (64.5%) were undergoing de novo ablation (p = .548). There were no statistically significant differences in fluoroscopy (p = .406) or total procedure times (p = .076), AAD use (p = .611), or procedural complications (p = .500) between groups. After multivariable adjustment, there were no statistically significant differences in recurrence of any atrial arrhythmias on or off AAD (adjusted hazard ratio [AHR]: 0.75; 95% confidence interval [CI]: 0.45–1.23; p = .252), all‐cause hospitalizations (AHR: 0.86; 95% CI: 0.46–1.60; p = .626), or all‐cause mortality (AHR: 4.48; 95% CI: 0.59–34.07; p = .147) between the very elderly and the younger cohort.ConclusionIn this registry analysis, catheter ablation of AF appears similarly effective and safe in patients 80 years or older when compared to a younger cohort.

Response to Letter to the Editor

“…We thank Kataoka et al for their comments regarding our recently published article on catheter ablation of atrial fibrillation in very elderly patients (≥80 years old) 1 . While the unadjusted time‐to‐event analysis may be more reflective of real‐world clinical practice, we adjusted for multiple potential confounders to more clearly assess the association of catheter ablation with all‐cause hospitalizations and mortality in the very elderly.…”

Efficacy and feasibility of catheter ablation in elderly patients with atrial fibrillation

“…Aldaas and colleagues demonstrated that catheter ablation for atrial fibrillation was similarly effective and feasible in patients aged 80 years or older when compared with a younger cohort. 1 Several concerns have been raised.…”

“…Elderly patients had a significantly higher cumulative incidence of all‐cause death/hospitalization after catheter ablation in their unadjusted comparative analyses. 1 This is not surprising as elderly patients have multiple comorbidities and more advanced sarcopenia than the younger cohort. These worse baseline characteristics may have a negative prognostic impact, regardless of the correction of atrial fibrillation.…”

“…The authors also adjusted for potential confounders, and the clinical outcomes of older patients were as good as those of younger patients. 1 However, the unadjusted time‐to‐event analyses may be more representative of real‐world clinical practice.…”

“…One of the procedural parameters missing from their study is the energy source. 1 How many patients underwent radiofrequency ablation and cryoballoon ablation, respectively? Efficacy and feasibility seem to be comparable between the two energy sources.…”