Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA.
J Cardiovasc Electrophysiol. 2012 Jan;23(1):36-43. doi: 10.1111/j.1540-8167.2011.02141.x. Epub 2011 Aug 1.
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.
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).
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).
射频导管消融（RFA）治疗心房颤动（AF）后脑血管事件（CVE）的相关因素在老年患者（≥65 岁）中尚未得到很好的定义。本研究的目的是确定≥65 岁 AF 患者 RFA 后 CVE 的发生率和预测因素，并与<65 岁患者进行比较，以及是否存在 AF。
本研究纳入了 508 例连续≥65 岁（平均年龄：70±4 岁）因阵发性（297 例）或持续性（211 例）AF 行 RFA 的患者。508 例<65 岁因 AF 行 RFA 的患者为对照组。所有患者 RFA 后均接受华法林抗凝≥3 个月。术后 4 周内发生围手术期 CVE（≤4 周）的患者分别占≥65 岁和<65 岁患者的 0.8%和 1%（P=1）。在 RFA 后仍保持窦性心律的≥65 岁患者中，CHADS₂评分分别为 0 和≥1 的患者中，分别有 60%和 56%停用华法林。阵发性 AF、无 CVE 史和 RFA 成功是停用华法林的独立预测因素。在平均 3±2 年的随访期间，508 例≥65 岁的患者中有 15 例（3%）（每年 1%）和 508 例<65 岁的患者中有 5 例（1%）（每年 0.3%）发生迟发性 CVE（RFA 后>4 周），P=0.03。在≥65 岁的患者中，年龄>75 岁（OR=4.9，95%CI：3.3-148.5，P=0.001）是 CVE 的唯一独立预测因素。在<65 岁的患者中，体重指数是迟发性 CVE 的唯一独立预测因素（OR=1.2，95%CI：1.03-1.33，P=0.02）。
RFA 治疗 AF 后围手术期 CVE 的风险在≥65 岁和<65 岁的患者中相似。与年轻患者相比，老年 AF 患者 RFA 后迟发性 CVE 更为常见，年龄>75 岁是迟发性 CVE 的唯一独立预测因素，无论节律、抗凝状态或 CHADS₂评分如何（充血性心力衰竭、高血压、年龄≥75 岁、糖尿病和既往卒中和短暂性脑缺血发作）。
