Department of Cardiology, CHA Bundang Medical Center, CHA University.
Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine.
Circ J. 2021 Jul 21;85(8):1305-1313. doi: 10.1253/circj.CJ-20-1062. Epub 2021 Mar 16.
It is unclear whether catheter ablation is beneficial for frail elderly patients with atrial fibrillation (AF). This study evaluated the effect of ablation on outcomes in frail elderly patients with AF.
From the Korean National Health Insurance Service database, 194,928 newly diagnosed AF patients were treated with ablation or medical therapy (rhythm or rate control) between 2005 and 2015. Among these patients, the study included 1,818 (ablation; n=119) frail and 1,907 (ablation; n=230) non-frail elderly (≥75 years) patients. Propensity score matching was used to correct for differences between groups. During 28 months (median) follow up, the risk of all-cause death, composite outcome (all-cause death, heart failure admission, stroke/systemic embolism, and sudden cardiac arrest), and each outcome did not change after ablation in frail elderly patients. However, in non-frail elderly patients, ablation was associated with a lower risk of all-cause death (3.5 and 6.2 per 100 person-years; hazard ratio [HR] 0.48; 95% confidence interval [CI] 0.30-0.79; P=0.004), and composite outcome (6.9 and 11.2 per 100 person-years; HR 0.54; 95% CI 0.38-0.75; P<0.001).
Ablation may be associated with a lower risk of death and composite outcome in non-frail elderly, but the beneficial effect of ablation was not significant in frail elderly patients with AF. The effect of frailty on the outcome of ablation should be evaluated in further studies.
对于有房颤（AF）的体弱老年患者，导管消融是否有益尚不清楚。本研究评估了消融对体弱老年 AF 患者结局的影响。
从韩国国家健康保险服务数据库中，2005 年至 2015 年间，194928 例新诊断的 AF 患者接受了消融或药物治疗（节律或心率控制）。在这些患者中，研究包括 1818 例（消融；n=119）体弱和 1907 例（消融；n=230）非体弱老年（≥75 岁）患者。采用倾向评分匹配校正组间差异。在 28 个月（中位数）的随访期间，在体弱老年患者中，消融后全因死亡、复合结局（全因死亡、心力衰竭入院、卒中和全身性栓塞以及心搏骤停）以及每种结局的风险均无变化。然而，在非体弱老年患者中，消融与全因死亡风险降低相关（3.5 和 6.2 例/100 人年；风险比 [HR] 0.48；95%置信区间 [CI] 0.30-0.79；P=0.004），复合结局风险也降低（6.9 和 11.2 例/100 人年；HR 0.54；95%CI 0.38-0.75；P<0.001）。
在非体弱老年患者中，消融可能与死亡和复合结局风险降低相关，但在有 AF 的体弱老年患者中，消融的有益效果不显著。进一步的研究应评估衰弱对消融结局的影响。
