Abstract
Introduction: Increasing numbers of elderly patients are undergoing catheter ablation (CA) of atrial fibrillation (AF). However, data regarding the experience with this procedure in the octogenarians are limited. Objective: To describe safety and efficacy of index CA of AF and predictors of arrhythmia recurrence in octogenarians. Methods: We conducted a retrospective analysis of patients > 80 years old undergoing index AF ablation between 2012 and 2020 at a large academic medical center. Procedural complications and efficacy, defined as freedom from any atrial tachyarrhythmia (ATA) lasting ≥30 seconds, were assessed. All patients were followed for at least 1 year. Predictors of ATA recurrence were also evaluated. Results: A total of 69 patients were included in our analysis. The median age was 82 (81-85) years, 53.6% were men, and 36.2% had persistent AF (PsAF). The mean left atrial (LA) diameter was 4.3 + 0.8 cm, while the median CHA 2 DS 2 -VASc score was 4 (3-4.5). The majority (n=48, 69.6%) underwent radiofrequency ablation, and the remaining (n=21, 30.4%) patients underwent cryoballoon ablation. Pulmonary vein (PV) isolation was performed in all patients, and 31 (44.9%) patients underwent additional non-PV ablation. None of the patients developed any procedural complications. Acute procedural success with PV isolation was achieved in all the patients, and a total of 44 (63.8%) patients remained free of ATA at 1-year of follow-up. Among the patients with ATA recurrence, 24 (34.8%) were on antiarrhythmic drugs, and 12 (17.4%) patients underwent repeat ablation. Anticoagulation was continued in all the patients. In a multivariable model, only AF type (PsAF) was associated with ATA recurrence at 1-year follow-up (HR=3.42, CI: 1.17-9.94, p=0.02). Conclusion: CA of AF appears to be a safe and effective procedure in octogenarians. AF type (PsAF) is an independent predictor of ATA recurrence at 1-year follow-up.
Published Version
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