title: Anticoagulant therapy and risk of cerebrovascular events after catheter ablation of atrial fibrillation in the elderly.
abstract: BACKGROUND
  Factors associated with cerebrovascular events (CVEs) after radiofrequency catheter ablation (RFA) of atrial fibrillation (AF) have not been well defined in elderly patients (≥65 years). The purpose of this study was to determine the prevalence and predictors of CVEs after RFA in patients with AF ≥65 years old, in comparison to patients <65 years, and with or without AF.
  
  
  RESULTS
  This study included 508 consecutive patients ≥65 years old (mean age: 70 ± 4 years), who underwent RFA for paroxysmal (297) or persistent (211) AF. A stratified group of 508 patients < 65 years old who underwent RFA for AF served as a control group. All patients were anticoagulated with warfarin for ≥3 months after RFA. A perioperative CVE (≤4 weeks after RFA) occurred in 0.8% and 1% of patients ≥65 and <65 years old, respectively (P = 1). Among the patients ≥65 years old who remained in sinus rhythm after RFA, warfarin was discontinued in 60% and 56% of the patients with a CHADS(2) score of 0 and ≥1, respectively. Paroxysmal AF, no history of CVE, and successful RFA were independent predictors of discontinuing warfarin. During a mean follow-up of 3 ± 2 years, a late CVE (>4 weeks after the RFA) occurred in 15 of 508 (3%) of patients ≥65 years old (1% per year) and in 5 of 508 (1%) patients <65 years old (0.3% per year, P = 0.03). Among patients ≥65 years old, age >75 years old (OR = 4.9, ±95% CI: 3.3-148.5, P = 0.001) was the only independent predictor of a CVE. Among patients <65 years old, body mass index was the only independent predictor of a late CVE (OR = 1.2, ±95% CI: 1.03-1.33, P = 0.02).
  
  
  CONCLUSIONS
  The risk of a periprocedural CVE after RFA of AF is similar among patients ≥65 and <65 years old. Late CVEs after RFA are more prevalent in older than younger patients with AF, and age >75 years old is the only independent predictor of late CVEs regardless of the rhythm, anticoagulation status, or the CHADS(2) score (Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes mellitus and prior Stroke or transient ischemic attack).
authors.affiliation: Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Aurelie
authors.initials: A
authors.lastname: Guiot
authors.forename: Krit
authors.initials: K
authors.lastname: Jongnarangsin
authors.forename: Aman
authors.initials: A
authors.lastname: Chugh
authors.forename: Arisara
authors.initials: A
authors.lastname: Suwanagool
authors.forename: Rakesh
authors.initials: R
authors.lastname: Latchamsetty
authors.forename: James D
authors.initials: JD
authors.lastname: Myles
authors.forename: Qingmei
authors.initials: Q
authors.lastname: Jiang
authors.forename: Thomas
authors.initials: T
authors.lastname: Crawford
authors.forename: Eric
authors.initials: E
authors.lastname: Good
authors.forename: Frank
authors.initials: F
authors.lastname: Pelosi
authors.forename: Frank
authors.initials: F
authors.lastname: Bogun
authors.forename: Fred
authors.initials: F
authors.lastname: Morady
authors.forename: Hakan
authors.initials: H
authors.lastname: Oral
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy* / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000517:prevention & control*; D016009:Chi-Square Distribution; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D018579:Patient Selection; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D014859:Warfarin