Assessment of the safety and efficacy of catheter ablation for atrial fibrillation in very elderly patients: insight from the national prospective registry study.

BACKGROUND AND AIMS

This study evaluated the safety and efficacy of catheter ablation in treating atrial fibrillation (AF) among the elderly population.

METHODS AND RESULTS

A total of 170 017 AF ablation procedures prospectively enrolled from 482 facilities between 2017 and 2020 were analysed. They were stratified into six age groups, ranging from <65 to ≥85 years, in 5-year increments. A cut-off of 80 years was set for dividing participants into two groups. The primary endpoints included procedure-related complications and 1-year arrhythmia recurrence after a 3-month blanking period. Patients ≥80 years constituted 7.2% of procedures in 2017, which significantly increased to 9.6% by 2020 (P < 0.001). This older group predominantly comprised women with smaller stature and body mass index, a higher prevalence of paroxysmal AF, and a higher rate of initial ablation procedures. The overall complication rate was 2.8%, showing a positive correlation with age (P < 0.001), peaking at 4.3% for patients ≥85 years. Older age remained a significant independent risk factor for complications (odds ratio: 1.36 [1.24, 1.49], P < 0.001). Cardiac tamponade, ischaemic stroke, and sick sinus syndrome were more common in the elderly. The recurrence rate in the total population was 16.0% and did not differ significantly between age groups (log-rank P = 0.473), remaining consistent even after adjusting for multiple variables.

CONCLUSION

Although age increases complication risk, recurrence rates remained steady across age groups, suggesting that AF ablation is a reasonable option for elderly individuals, contingent on careful patient selection for safety.