Abstract
Published reports of atrial fibrillation (AF) treatment by catheter ablation (CA) included typically relatively young healthy individuals, but long-term outcomes of CA in elderly patients (PTs) remain unclear. We thus carried out the following study aiming to determine: 1) Safety and efficacy of CA in elderly PTs in maintaining sinus rhythm; 2) Risks of discontinuation of anti-coagulation in patients who remained in sinus rhythm (SR) after the ablation. Methods: We evaluated 302 elderly AF PTs (> 75 years old); 246 PTs (mean age = 80) underwent CA guided by complex fractionated atrial electrogram (CFAE); 85 were paroxysmal AF, 46 persistent AF and 115 long-lasting AF. The remaining 56 patients (mean age = 79) declined the procedure. The clinical end points were SR, stroke, death and major bleeding. Warfarin was discontinued if sinus rhythm was maintained or AF burden < 5% with no AF episodes was > 12 hours. Results: After a mean follow-up of 3 + 6 years including multiple ablations, 196 Patients (79 %) remained in SR. The annual death rate was 4% vs. 10% in PTs who stayed in SR vs. those remained in AF after ablations respectively (p < 0.001); interestingly, the annual death rate was also at 11% in patients who declined ablation. We were able to discontinue warfarin in 164 patients (70%) who had a stroke rate only 1.08 per 100 person -year compared to 2.62 per 100 person-year in patients who continued to have AF and stayed on coumadin (p <0.01). Patients with CHADS score > 2, who stayed in SR and stopped warfarin, had a stroke rate of 2 per 100 person-year compared to 0.98 for those with CHADS score 1. Major complications were groin bleeding (n= 9 [4%]), 2 patients had stroke (1 intracranial hemorrhage leading to death at home) and 2 patients had hemopericardium. Conclusions: Our data suggest that elderly PTs with AF benefit from AF substrate ablation which is safe and effective in maintain SR. Warfarin could be safely discontinued after SR is maintained post ablation. Our data suggest that SR after CA is associated with lower mortality and stroke risks.
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