title: Long-term clinical efficacy and risk of catheter ablation for atrial fibrillation in the elderly.
abstract: BACKGROUND
  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 > or =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.
authors.affiliation: Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Erica
authors.initials: E
authors.lastname: Zado
authors.forename: David J
authors.initials: DJ
authors.lastname: Callans
authors.forename: Michael
authors.initials: M
authors.lastname: Riley
authors.forename: Mathew
authors.initials: M
authors.lastname: Hutchinson
authors.forename: Fermin
authors.initials: F
authors.lastname: Garcia
authors.forename: Rupa
authors.initials: R
authors.lastname: Bala
authors.forename: David
authors.initials: D
authors.lastname: Lin
authors.forename: Joshua
authors.initials: J
authors.lastname: Cooper
authors.forename: Ralph
authors.initials: R
authors.lastname: Verdino
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Russo
authors.forename: Sanjay
authors.initials: S
authors.lastname: Dixit
authors.forename: Edward
authors.initials: E
authors.lastname: Gerstenfeld
authors.forename: Francis E
authors.initials: FE
authors.lastname: Marchlinski
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome