Boehmer Andreas A, Rothe Moritz, Ruckes Christian, Eckardt Lars, Kaess Bernhard M, Ehrlich Joachim R
Department of Cardiology, St Josefs-Hospital, Wiesbaden, Germany. Electronic address: https://twitter.com/anboehmer.
Department of Cardiology, St Josefs-Hospital, Wiesbaden, Germany.
Can J Cardiol. 2024 Dec;40(12):2441-2451. doi: 10.1016/j.cjca.2024.08.263. Epub 2024 Aug 9.
Age is a relevant risk factor for the development of atrial fibrillation (AF) and is associated with increased recurrence rates in the setting of rhythm control. Catheter ablation is increasingly advocated in elderly despite conflicting data regarding its efficacy and safety in this patient cohort. Therefore, we aimed to analyse currently available evidence regarding catheter ablation for AF in patients ≥ 75 years old compared with younger patients.
We performed a systematic literature search and meta-analysis on efficacy and safety of catheter ablation in patients ≥ 75 years old with AF. Primary efficacy and safety end points were first recurrence of atrial arrhythmia after first-time ablation and occurrence of death, stroke, or any procedure-related complication. Secondary outcomes included procedure and fluoroscopy time.
We identified 301 potentially relevant studies, of which 39 underwent detailed analysis. A total of 19 studies (MINORS score ≥ 13) reporting on 108,419 patients (101,844 < 75 years, 6,575 ≥ 75 years of age) undergoing first-time catheter ablation for AF were included. Risk of arrhythmia recurrence after catheter ablation (39% vs 32%, relative risk [RR] 1.24, 95% confidence interval [CI] 1.09-1.41; P = 0.001) and occurrence of safety end points (10.8% vs 8.5%; RR 1.64, 95% CI 1.53-1.76; P < 0.00001) were significantly higher in patients ≥ 75 years of age than in younger patients. There was no difference concerning procedure (P = 0.33) or fluoroscopy time (P = 0.91) between younger and elderly patients.
In patients ≥ 75 years of age, catheter ablation for AF has higher risk of arrhythmia recurrence and is associated with an increased risk of procedure-related complications and safety end point occurrence compared with younger patients.
年龄是心房颤动（AF）发生的一个相关风险因素，并且在节律控制的情况下与复发率增加相关。尽管关于导管消融在该患者群体中的疗效和安全性数据存在矛盾，但在老年患者中越来越多地提倡进行导管消融。因此，我们旨在分析目前关于≥75岁患者与年轻患者相比进行AF导管消融的现有证据。
我们对≥75岁AF患者进行导管消融的疗效和安全性进行了系统的文献检索和荟萃分析。主要疗效和安全性终点是首次消融后房性心律失常的首次复发以及死亡、中风或任何与手术相关并发症的发生。次要结局包括手术时间和透视时间。
我们确定了301项潜在相关研究，其中39项进行了详细分析。总共纳入了19项研究（MINORS评分≥13），报告了108419例接受首次AF导管消融的患者（101844例年龄＜75岁，6575例≥75岁）。≥75岁患者导管消融后心律失常复发风险（39%对32%，相对风险[RR]1.24，95%置信区间[CI]1.09 - 1.41；P = 0.001）和安全性终点的发生率（10.8%对8.5%；RR 1.64，95%CI 1.53 - 1.76；P＜0.00001）显著高于年轻患者。年轻患者和老年患者之间在手术时间（P = 0.33）或透视时间（P = 0.91）方面没有差异。
与年轻患者相比，≥75岁患者进行AF导管消融有更高的心律失常复发风险，并且与手术相关并发症和安全性终点发生风险增加相关。
