Catheter ablation for atrial fibrillation in the elderly

Abstract

SUMMARY An important proportion of patients suffering from atrial fibrillation (AF) are in the patient age group over 65 years. Cardiac and noncardiac comorbidities are often present at this age and are challenging for pharmacological management. In the setting of hypertension, coronary artery disease, heart failure and left ventricular hypertrophy, specific antiarrhythmic drugs frequently fail due to adverse effects, proarrhythmic properties or impaired efficacy. Recently, catheter ablation became widely available as an effective therapy for symptomatic AF. However, a small number of elderly patients were enrolled in the large randomized trials, and international guidelines recommend a conservative strategy in elderly patients as the evidence-based data are limited. Nevertheless, our findings and the data of other groups show that ablation therapy is effective with acceptable risks for selected elderly patients even at octogenarian age, if AF is symptomatic despite pharmacological rate and rhythm control...