Radiofrequency catheter ablation of atrial fibrillation in older patients: outcomes and complications
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Catheter ablation (CA) of atrial fibrillation (AF) has become a treatment option for younger patients with drug refractory AF. It is not known whether pulmonary veins (PV) have an important mechanistic role in elderly patients with AF or whether CA is an effective treatment for the elderly.
We evaluated 240 consecutive patients that were referred to the electrophysiology laboratory for CA for AF using a PV antral isolation approach. Linear ablations were not routinely performed. Clinical outcomes and healthcare resource utilization was evaluated during the 12 months after CA in patients <65 years old (Group 1; 91 patients), 65–75 years old (Group II; 88 patients), and >75 years old (Group III; 61 patients).
Older patients were more likely to have persistent atrial fibrillation (I: 24%, II: 34%, III: 66%). Major complication rates (I: 1%; II: 1%; III: 0%; p=ns) and minor complication rates (I: 4%; II: 5%; III: 5%; p=ns) were similar for all three groups. At 12 month follow-up younger patients were more likely to be in sinus rhythm without prolonged episodes of atrial fibrillation without antiarrhythmic drug therapy (AARx) (I: 94%, II: 84%, III: 61%). However in Group III, effective treatment (AF <1 h/mo ± AARx) was achieved in 82% of patients. After radiofrequency catheter ablation, hospitalizations, emergency room and nonroutine clinic visits decreased significantly for all three groups during the 12 months after RFA (I: pre 22; post: 3; Group II: pre 26; post 4; III: pre 20; post 2).
CA can be effective for treating AF in selected older patients as stand-alone therapy or as hybrid therapy with AARx. PVs appear to be an important arrhythmogenic structure regardless of age. CA is associated with decreased healthcare resource utilization in all age groups.
KeywordsAblation Atrial fibrillation Elderly
- 1.Miyasaka, Y., Barnes, M. E., Gersh, B. J., Cha, S. S., Bailey, K. R., Abhayaratna, W. P., et al. (2006). Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation, 114, 119–125.PubMedCrossRefGoogle Scholar
- 6.Pappone, C., Manguso, F., Vicedomini, G., Gugliotta, F., Santinelli, O., Ferro, A., et al. (2004). Prevention of iatrogenic atrial tachycardia after ablation of atrial fibrillation: a prospective randomized study comparing circumferential pulmonary vein ablation with a modified approach. Circulation, 110, 3036–3042.PubMedCrossRefGoogle Scholar
- 8.Calkins, H., Brugada, J., Packer, D. L., Cappato, R., Chen, S. A., Crijns, H. J., et al. (2007). HRS/EHRA/ECAS expert Consensus Statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on catheter and surgical ablation of atrial fibrillation. Heart Rhythm, 4, 816–861.PubMedCrossRefGoogle Scholar
- 9.Fuster, V., Rydén, L. E., Cannom, D. S., Crijns, H. J., Curtis, A. B., Ellenbogen, K. A., et al. (2006). ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation, 114, e257–e354.PubMedCrossRefGoogle Scholar