Safety of catheter ablation for atrial fibrillation in the octogenarian population

Abstract

Introduction Catheter ablation (CA) has been shown to be an effective treatment for atrial fibrillation (AF). The complication rates and outcomes among octogenarians remain poorly studied. We aimed to compare trends, morbidity, and mortality associated with CA for AF among octogenarians versus those less than 80 years old. Methods Using weighted sampling from the National Inpatient Sample database, we identified patients with a primary diagnosis of AF and a primary procedure of CA (2004‐2013). Our primary outcome was mortality. Secondary outcomes included incidence of major and minor complications. Results Among 86,119 patients who underwent CA for AF, 3,482 were 80 years old or older. Complications were significantly more frequent in octogenarians; [16.2% (564 of 3,482) versus 9.8% (8,092 of 82,637), P < 0.001]. Of note, there was no significant difference for the composite of major complications; [3.6% (124 of 3482) in octogenarians versus 2.8% (2286 of 82637), P = 0.20]. The total mortality rate was not significant in a multivariate regression analysis (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.35‐2.64; P = .94). The presence of chronic renal failure (OR, 4.19; 95% CI, 2.75‐6.36; P < 0.001), anemia (OR, 1.75; 95% CI, 1.03‐2.97; P = .04), and chronic pulmonary disease (OR, 1.75; 95% CI, 1.11‐2.62; P = .015) were predictors of major complications in octogenarians. Conclusion Catheter ablation for AF in octogenarians does not confer a higher mortality risk than in those less than 80 years old. The procedure is associated with a higher rate of overall complications but there was no difference in terms of major complications or death. The presence of anemia, CKD or pulmonary disease were predictors of major complications in octogenarians.

Clinical efficacy and safety of radiofrequency catheter ablation for atrial fibrillation in patients aged ≥80 years

“…In this study, the incidence of overall and major complications is 3.6% and 1.5%, respectively. The difference in complications rate may be related to the definition of complications, such as pneumonia (4.2%) and acute renal failure (8.3%), which were reported by Romero et al with a high rate in octogenarians but not included in our study 11. Thus, a lower complications rate was acceptable.…”

“…It is reasonable that the complication rate of catheter ablation in elderly patients with AF is higher than that of younger patients, due to more comorbidities, advanced frailty, and lower patient compliance. In a recent retrospective multicenter study with a large sample size, Romero et al found that complications were significantly more frequent in octogenarians compared to those <80 years (16.2%, 564/3482 vs 9.8%, 8092/82637, P < .001), with no significant difference for the composite of major complications (3.6% vs 2.8%, P = .20) 11 . In this study, the incidence of overall and major complications is 3.6% and 1.5%, respectively.…”

“…With the population ageing, the elderly are more likely to develop AF and have more associated comorbidities, including hypertension, CAD, congestive heart failure, diabetes, and stroke 9,11 . Thus, the elderly has an increased risk of embolism and bleeding.…”

“…With the population ageing, the elderly are more likely to develop AF and have more associated comorbidities, including hypertension, CAD, congestive heart failure, diabetes, and stroke. 9,11 Thus, the elderly has an increased risk of embolism and bleeding. In the present study, the prevalence of comorbidities in patients aged ≥80 years was quite 6,12,13 and the characteristics of the study population could not truly reflect the characteristics of AF cohort aged ≥80 years.…”

Mortality and morbidity in patients with atrial fibrillation and liver cirrhosis

“…This study comes with limitations inherent to retrospective analysis[ 16 - 19 ]. Mainly, the NIS database consists of time-limited administrative data that is related to a specific hospitalization.…”