Fusco Alessandra, Hansen Morten Lock, Ruwald Martin H, Zörner Christopher R, Riis-Vestergaard Lise, Middelfart Charlotte, Hein Regitze, Rasmussen Peter Vibe, Di Sabatino Antonio, Gislason Gunnar, Tønnesen Jacob
Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy; First Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Pavia, Italy.
Department of Cardiology, Herlev-Gentofte University Hospital, University of Copenhagen, Hellerup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
JACC Clin Electrophysiol. 2025 Jan;11(1):83-94. doi: 10.1016/j.jacep.2024.09.024. Epub 2024 Nov 13.
The elderly population with atrial fibrillation (AF) is growing. There is limited evidence to suggest AF ablation as an effective treatment for the elderly.
This study aimed to investigate the temporal trends of first-time ablations in the elderly, the impact of age on major adverse cardiovascular events (MACE), and a composite endpoint of AF-related hospitalizations, repeat AF ablation, or use of antiarrhythmic drugs (AADs).
Utilizing the Danish administrative registers, we incorporated individuals undergoing their first-time AF ablation from 2001 to 2020. Our cohort was divided into 3 age groups (<60, 60-74, and ≥75 years) and scrutinized across 4 consecutive 5-year intervals. Cox proportional-hazard multivariable analyses and cumulative incidences were used to evaluate the endpoints of 5-year MACE incidence and a 1-year composite endpoint of AF-related hospitalizations, repeat AF ablation, or use of antiarrhythmic drugs.
Elderly patients who underwent AF ablation increased significantly, from none in 2001 to 9% in 2020. The 5-year incidence of MACE in the elderly decreased from 61.9% (95% CI: 41.1%-82.7%) to 38.1% (95% CI: 31.9%-44.2%). The HR for age ≥75 years in the last time period was 1.52 (95% CI: 1.26-1.83). The 1-year composite outcome varied from 35.6% to 52.0%; age was not a consistent predictor.
AF ablation use in the elderly has significantly increased over time. A notable decrease in MACE was evident across all age cohorts, with a particularly pronounced trend observed among the elderly population. Age was not an independent predictor of the composite endpoint.
患有心房颤动（AF）的老年人口正在增加。几乎没有证据表明房颤消融术对老年人是一种有效的治疗方法。
本研究旨在调查老年人首次消融术的时间趋势、年龄对主要不良心血管事件（MACE）的影响，以及房颤相关住院、重复房颤消融术或使用抗心律失常药物（AAD）的复合终点。
利用丹麦行政登记册，纳入了2001年至2020年期间首次进行房颤消融术的个体。我们的队列分为3个年龄组（<60岁、60-74岁和≥75岁），并在连续4个5年间隔内进行审查。采用Cox比例风险多变量分析和累积发病率来评估5年MACE发病率的终点以及房颤相关住院、重复房颤消融术或使用抗心律失常药物的1年复合终点。
接受房颤消融术的老年患者显著增加，从2001年的零例增加到2020年的9%。老年人5年MACE发病率从61.9%（95%CI：41.1%-82.7%）降至38.1%（95%CI：31.9%-44.2%）。最后一个时间段内年龄≥75岁的HR为1.52（95%CI：1.26-1.83）。1年复合结局从35.6%到52.0%不等；年龄不是一个一致的预测因素。
随着时间的推移，老年人房颤消融术的使用显著增加。所有年龄组的MACE均显著下降，在老年人群中观察到特别明显的趋势。年龄不是复合终点的独立预测因素。
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