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Keywords:

  • antiarrhythmic drugs;
  • catheter ablation;
  • elderly patients;
  • persistent atrial fibrillation;
  • quality of life;
  • stroke

Ablation versus Drugs in Elderly Persistent AF

Background

We prospectively compared the efficacy, safety, and quality of life (QoL) impact of catheter ablation versus antiarrhythmic drugs (AAD) in elderly patients with persistent atrial fibrillation (AF).

Methods and Results

Four hundred and twelve consecutive patients, aged ≥ 70 years, underwent ablation (Group A, 153 patients) or AAD (Group B, 259 patients). Study endpoints: treatment failure (any AF/AT lasting >30 seconds) and treatment-related adverse events (acute when ≤1 month of procedure and long term when >1 month). At a follow-up of 60 ± 17 months, 43% and 46% patients in Group B versus 58% and 76% in Group A were in sinus rhythm (SR), respectively, after one (P = 0.003) and 2 procedures (P < 0.001). Fifteen acute adverse events occurred (6.7% in Group A vs 1% in Group B, P < 0.001), mainly periprocedural cerebral thromboembolism (3.3% in Group A vs 0.7% in Group B, P = 0.058). Previous TIA/stroke resulted the only independent predictor of periprocedural cerebrovascular accidents (OR 1.2, 95%IC 1.1–1.3). At follow-up, 74 long-term adverse events occurred (7.7% in Group A vs 23.9% in Group B, P < 0.001) with Group B patients more often experiencing AAD-related adverse events (12.7% vs 2.6%, P < 0.001). Group A and absence of AF/AT recurrences significantly improved QoL scores (P < 0.001).

Conclusions

In elderly persistent AF patients, catheter ablation is more effective in maintaining SR and in improving QoL than AAD but is affected by a higher risk of embolic complications, particularly in patients with previous TIA/stroke. Over time, Group A patients more likely discontinued AAD with a reduction of long-term adverse events.