title: Catheter ablation of atrial fibrillation in octogenarians: safety and outcomes.
abstract: BACKGROUND
  Radiofrequency catheter ablation (RFCA) is an effective treatment for atrial fibrillation (AF), although studies evaluating the role of RFCA have largely excluded elderly patients. We report the safety and outcomes of RFCA of AF in octogenarians.
  
  
  RESULTS
  From 2008 to 2011, out of 2,754 consecutive patients undergoing RFCA of AF, 103 (3.7%) had ≥80 years (age 85 ± 3 years, 4 with >90 years). Pulmonary vein (PV) antrum isolation was performed in paroxysmal AF. In nonparoxysmal AF, ablation was extended to the entire left atrial posterior wall and to complex fractionated electrograms. Non-PV triggers were disclosed by isoproterenol challenge at the end of the procedure and targeted for ablation. Octogenarians presented a high rate of non-PV triggers (84% vs 69%, P = 0.001), especially in patients with paroxysmal AF (62% vs 19%, P < 0.001); non-PV triggers were most commonly mapped in the coronary sinus (54%), left atrial appendage (32%), interatrial septum and superior vena cava (14%). After a mean follow-up of 18 ± 6 months, 71 (69%) octogenarians remained free from AF recurrence off antiarrhythmic drugs after a single procedure (vs 71% in patients <80 years, P = 0.65). The success rate reached 87% after 2 procedures. Total periprocedural complication rates also did not differ between the 2 age groups.
  
  
  CONCLUSIONS
  RFCA of AF is safe and effective in octogenarians. A high rate of non-PV triggers is present in these patients, and targeting multiple structures other than the pulmonary veins is often necessary to achieve long-term success.
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas 78705, USA.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Santangeli
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.forename: Prasant
authors.initials: P
authors.lastname: Mohanty
authors.forename: J David
authors.initials: JD
authors.lastname: Burkhardt
authors.forename: Rodney
authors.initials: R
authors.lastname: Horton
authors.forename: Rong
authors.initials: R
authors.lastname: Bai
authors.forename: Sanghamitra
authors.initials: S
authors.lastname: Mohanty
authors.forename: Agnes
authors.initials: A
authors.lastname: Pump
authors.forename: Douglas
authors.initials: D
authors.lastname: Gibson
authors.forename: Linda
authors.initials: L
authors.lastname: Couts
authors.forename: Richard
authors.initials: R
authors.lastname: Hongo
authors.forename: Salwa
authors.initials: S
authors.lastname: Beheiry
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D020517:Atrial Appendage / Q000503:physiopathology / Q000601:surgery; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D054087:Atrial Septum / Q000503:physiopathology / Q000601:surgery; D017115:Catheter Ablation / Q000009:adverse effects; D054326:Coronary Sinus / Q000503:physiopathology / Q000601:surgery; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011237:Predictive Value of Tests; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014683:Vena Cava, Superior / Q000503:physiopathology / Q000601:surgery
chemical_list: D000889:Anti-Arrhythmia Agents