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. 2023 Dec;46(12):1488-1494.
doi: 10.1002/clc.24137. Epub 2023 Aug 25.

Safety and efficacy of catheter ablation of atrial fibrillation in the very elderly (≥80 years old): Insights from the UC San Diego AF Ablation Registry

Omar M Aldaas  1 , Douglas Darden  1 , Praneet S Mylavarapu  1 , Amer M Aldaas  2 , Frederick T Han  1 , Kurt S Hoffmayer  1 , David Krummen  1 , Gordon Ho  1 , Farshad Raissi  1 , Gregory K Feld  1 , Jonathan C Hsu  1
Affiliations

Safety and efficacy of catheter ablation of atrial fibrillation in the very elderly (≥80 years old): Insights from the UC San Diego AF Ablation Registry

Omar M Aldaas et al. Clin Cardiol. 2023 Dec.

Abstract

Background: Catheter ablation improves outcomes in symptomatic atrial fibrillation (AF) patients. However, its safety and efficacy in the very elderly (≥80 years old) is not well described.

Hypothesis: Ablation of AF in the very elderly is safe and effective.

Methods: We performed a retrospective study of all patients who underwent catheter ablation enrolled in the University of California, San Diego AF Ablation Registry. The primary outcome was freedom from atrial arrhythmias on or off antiarrhythmic drugs (AADs).

Results: Of 847 patients, 42 (5.0%) were 80 years of age or greater with a median age of 81.5 (80-82.3) and 805 (95.0%) were less than 80 years of age with a median age of 64.4 (57.6-70.2). Among those who were ≥80 years old, 29 were undergoing de novo ablation (69.0%), whereas in the younger cohort, 518 (64.5%) were undergoing de novo ablation (p = .548). There were no statistically significant differences in fluoroscopy (p = .406) or total procedure times (p = .076), AAD use (p = .611), or procedural complications (p = .500) between groups. After multivariable adjustment, there were no statistically significant differences in recurrence of any atrial arrhythmias on or off AAD (adjusted hazard ratio [AHR]: 0.75; 95% confidence interval [CI]: 0.45-1.23; p = .252), all-cause hospitalizations (AHR: 0.86; 95% CI: 0.46-1.60; p = .626), or all-cause mortality (AHR: 4.48; 95% CI: 0.59-34.07; p = .147) between the very elderly and the younger cohort.

Conclusion: In this registry analysis, catheter ablation of AF appears similarly effective and safe in patients 80 years or older when compared to a younger cohort.

Keywords: atrial fibrillation; catheter ablation; complications; hospitalizations; mortality; very elderly.

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Conflict of interest statement

Dr. Hsu reports receiving honoraria from Medtronic, Abbott, Boston Scientific, Biotronik, Janssen Pharmaceuticals, Bristol‐Myers Squibb, Pfizer, Sanofi, Zoll Medical, Hillrom, iRhythm, Acutus Medical, and Biosense‐Webster, equity interest in Vektor Medical, research grants from Biotronik and Biosense‐Webster, and research funding support from the Marouf Family and the Butler and Gratt family. Dr. Ho reports receiving a research grant from Abbott, equity in Vektor Medical, and fellowship support from Medtronic, Abbott, Boston Scientific, and Biotronik. Dr. Feld reports receiving fellowship training program stipends (as CCEP fellowship training program director) from Medtronic, Biotronik, Biosense Webster, and Abbott Medical, has equity interest in Vektor Medical, is co‐founder and co‐owner of Perminova, and is a consultant to Acutus Medical. Dr Han receives research support from Abbott and honoraria from Abbott. Dr. Aldaas, Dr. Darden, Dr. Mylavarapu, Amer Aldaas, Dr. Hoffmayer, Dr. Krummen, and Dr. Raissi have no conflicts of interest to disclose

Figures

Figure 1
Figure 1
Kaplan–Meier plots of (A) long‐term recurrence of atrial arrhythmias (AF/AFL/AT) on or off antiarrhythmic drugs (excluding a 3‐month postprocedural blanking period), and (B) long‐term recurrence of atrial arrhythmias (AF/AFL/AT) off antiarrhythmic drugs. Patients who were 80 years of age or older and a younger cohort are compared. AAD, antiarrhythmic drug; AF, atrial fibrillation; AFL, atrial flutter; AT, atrial tachycardia.
Figure 2
Figure 2
Kaplan–Meier plots of (A) long‐term rate of all‐cause hospitalizations and (B) long‐term rate of all‐cause mortality. Patients who were 80 years of age or older and a younger cohort are compared.
See this image and copyright information in PMC

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