Long-term clinical efficacy and risk of catheter ablation for atrial fibrillation in octogenarians.
BACKGROUND
Radiofrequency ablation is an effective treatment for atrial fibrillation (AF). With improved safety, the therapy has been offered to increasingly older populations. Arrhythmia mechanisms, medical comorbidities, and safety may vary in the very elderly population.


METHODS
Patients presenting for AF ablation were divided into two groups [> or =80 years (n = 35), <80 years (n = 717)]. AF ablation consisted of pulmonary vein antral isolation with or without additional linear lesions. A successful outcome was defined as no further AF and off all antiarrhythmic medications >3 months following 1 + ablation procedures.


RESULTS
The type of AF was similar in both groups (paroxysmal: 46% in the older group vs 54% in the younger, P = 0.33). Older patients were more likely to have a higher CHADS2 score, coronary artery disease, and less likely to have had a prior ablation. The hospital stay on average was longer in the older cohort (2.9 +/- 7.7 vs 2.1 +/- 1.1 days, P = 0.001). There was no increased risk of peri-procedural complications. One-year survival free of AF or flutter was 78% in those >80 and 75% in those younger (P = 0.78). There was no difference between groups if the AF was paroxysmal (P = 0.44) or persistent/chronic (P = 0.74). Over a 3-year follow-up period, five patients died and four strokes occurred all in the younger cohort.


CONCLUSIONS
Octogenarian patients, despite more coexistent cardiovascular diseases, have favorable outcomes after AF ablation measured by successful rhythm management. On an average their hospital stay is longer, but no significant increase in short- or long-term complications was observed. These data support AF ablation in select octogenarians.
Bunch
T Jared
TJ
Intermountain Heart Rhythm Specialists, Intermountain Medical Center, Eccles Outpatient Care Center, 5169 Cottonwood St., Murray, UT 84107, USA. thomas.bunch@imail.org
Weiss
J Peter
JP
Crandall
Brian G
BG
May
Heidi T
HT
Bair
Tami L
TL
Osborn
Jeffrey S
JS
Anderson
Jeffrey L
JL
Lappe
Donald L
DL
Muhlestein
J Brent
JB
Nelson
Jennifer
J
Day
John D
JD
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents