Long-Term Clinical Efficacy and Risk of Catheter Ablation for Atrial Fibrillation in the Elderly

Authors


  • Dr. Hutchinson has participated on a research grant from Biosense-Webster.

  • Manuscript received 6 February 2008; Revised manuscript received 27 February 2008; Accepted for publication 7 March 2008.

Address for correspondence: Francis E. Marchlinski, M.D., Director, Cardiac Electrophysiology, 9 Founders Pavilion, 3400 Spruce Street, Philadelphia, PA 19104, USA. Fax: 215-662-2879; E-mail: francis.marchlinski@uphs.upenn.edu

Abstract

Introduction: The number of elderly patients with atrial fibrillation (AF) is increasing rapidly, and the safety and efficacy of catheter ablation in this demographic group has not been established.

Methods: Over a 7-year period we studied 1,165 consecutive patients undergoing 1,506 AF ablation procedures using a consistent ablation protocol that included proximal ostial pulmonary vein (PV) isolation and focal ablation of non-PV AF triggers. Outcome was analyzed for three distinct age groups: <65 years (group 1; n = 948 patients), 65–74 years (group 2; n = 185 patients), and ≥75 years (group 3; n = 32 patients) based on the age at the initial procedure.

Results: There was no significant difference in AF control (89% in group 1, 84% in group 2, and 86% in group 3, P = NS) during a mean follow-up of 27 months. Major complication rates were also comparable (1.6% in group 1, 1.7% in group 2, 2.9% in group 3, P = NS) between the three groups. There was no difference in the left atrial size, percentage with left ventricular ejection fraction <50%, or percentage with paroxysmal versus more persistent forms of atrial fibrillation. However, older patients were more likely to be women (20% in group 1, 34% in group 2, and 56% in group 3, P < 0.001) and have hypertension and/or structural heart disease (56% in group 1 vs 68% in group 2 vs 88% in group 3; P < 0.001). There was a strong trend demonstrating that older patients were less likely to undergo repeat ablation (26% vs 27% vs 9%) to achieve AF control and more likely to remain on antiarrhythmic drugs (20% vs 29% vs 37%; P < 0.05).

Conclusions: Elderly patients with AF undergoing catheter ablation therapy are represented by a higher proportion of women and have a higher incidence of hypertension/structural heart disease. To achieve a similar level of AF control, there appears to be no increased risk from the ablation procedure, but elderly patients are more likely to remain on antiarrhythmic drugs.

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