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

• Published in: Clinical cardiology (Mahwah, N.J.) N.J.), 2023-12, Vol.46 (12), p.1488-1494
• Main Authors: Aldaas, Omar M., Darden, Douglas, Mylavarapu, Praneet S., Aldaas, Amer M., Han, Frederick T., Hoffmayer, Kurt S., Krummen, David, Ho, Gordon, Raissi, Farshad, Feld, Gregory K., Hsu, Jonathan C.
• Format: Article
• Language: English
• Subjects: Ablation; Age; Aged; Aged, 80 and over; Anti-Arrhythmia Agents - therapeutic use; atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - diagnosis; Atrial Fibrillation - surgery; Body mass index; Cardiac arrhythmia; Cardiovascular disease; catheter ablation; Catheter Ablation - adverse effects; Catheter Ablation - methods; Catheters; Chronic obstructive pulmonary disease; Clinical Investigations; complications; Ejection fraction; Electrocardiography; Fistula; Heart failure; hospitalizations; Humans; Hypertension; mortality; Recurrence; Registries; Retrospective Studies; Treatment Outcome; Variables; very elderly
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.24137

Background Catheter 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. Hypothesis Ablation of AF in the very elderly is safe and effective. Methods We 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). Results Of 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. Conclusion In this registry analysis, catheter ablation of AF appears similarly effective and safe in patients 80 years or older when compared to a younger cohort. Kaplan–Meier plots of long‐term recurrence of atrial arrhythmias on or off antiarrhythmic drugs (excluding a 3‐month postprocedural blanking period), long‐term rate of all‐cause hospitalizations, and long‐term rate of all‐cause mortality. Patients who were 80 years of age or older and a younger cohort are compared.