Dr. Blandino's fellowship was sponsored by Biosense Webster. Other authors: No disclosures.
Long-Term Efficacy and Safety of Two Different Rhythm Control Strategies in Elderly Patients with Symptomatic Persistent Atrial Fibrillation
Article first published online: 1 APR 2013
© 2013 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 24, Issue 7, pages 731–738, July 2013
How to Cite
BLANDINO, A., TOSO, E., SCAGLIONE, M., ANSELMINO, M., FERRARIS, F., SARDI, D., BATTAGLIA, A. and GAITA, F. (2013), Long-Term Efficacy and Safety of Two Different Rhythm Control Strategies in Elderly Patients with Symptomatic Persistent Atrial Fibrillation. Journal of Cardiovascular Electrophysiology, 24: 731–738. doi: 10.1111/jce.12126
- Issue published online: 1 JUL 2013
- Article first published online: 1 APR 2013
- Accepted manuscript online: 27 FEB 2013 02:30PM EST
- Manuscript Accepted: 13 FEB 2013
- Manuscript Revised: 19 JAN 2013
- Manuscript Received: 29 NOV 2012
- antiarrhythmic drugs;
- catheter ablation;
- elderly patients;
- persistent atrial fibrillation;
- quality of life;
Ablation versus Drugs in Elderly Persistent AF
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).
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.