TY - JOUR
T1 - Long-term clinical efficacy and risk of catheter ablation for atrial fibrillation in the elderly
AU - Zado, Erica
AU - Callans, David J.
AU - Riley, Michael
AU - Hutchinson, Mathew
AU - Garcia, Fermin
AU - Bala, Rupa
AU - Lin, David
AU - Cooper, Joshua
AU - Verdino, Ralph
AU - Russo, Andrea M.
AU - Dixit, Sanjay
AU - Gerstenfeld, Edward
AU - Marchlinski, Francis E.
PY - 2008/6
Y1 - 2008/6
N2 - Atrial Fibrillation Ablation in the Elderly. Introduction: 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 ≥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.
AB - Atrial Fibrillation Ablation in the Elderly. Introduction: 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 ≥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.
KW - Ablation
KW - Atrial fibrillation
KW - Complications
KW - Geriatrics
KW - Stroke
UR - http://www.scopus.com/inward/record.url?scp=45549108720&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=45549108720&partnerID=8YFLogxK
U2 - 10.1111/j.1540-8167.2008.01183.x
DO - 10.1111/j.1540-8167.2008.01183.x
M3 - Article
C2 - 18462325
AN - SCOPUS:45549108720
SN - 1045-3873
VL - 19
SP - 621
EP - 626
JO - Journal of cardiovascular electrophysiology
JF - Journal of cardiovascular electrophysiology
IS - 6
ER -