Clinical outcomes of radiofrequency catheter ablation of atrial fibrillation in octogenarians-10-year experience of a one high-volume center.

Abstract

BackgroundPrevalence of atrial fibrillation (AF) increases with age. Radiofrequency catheter ablation (RFCA) is an established treatment option superior to antiarrhythmics (AAs). In this study, we investigated safety and efficacy of RFCA of AF in octogenarians.MethodsFrom our database, we extracted procedural and follow-up data for patients ≥ 80 years with symptomatic AF undergoing RFCA and compared this population to RFCA patients ≤ 50 years. All patients underwent pulmonary vein isolation (PVI) supplemented by linear lesions in PVI-nonresponders. Arrhythmia-free survival was assessed using seven day Holter every three months post procedure. All patients completed their 12 months follow-up.ResultsFifty patients aged ≥ 80 years (80.5 ± 1.6 years) were compared to 259 patients aged ≤ 50 years (43.5 ± 5.5 years). The RFCA complication rate did not vary between groups. No differences in procedural characteristics were seen after being analyzed by type of AF. Among patients with paroxysmal AF, 71.4% octogenarian vs. 84.7% young patients was free of any arrhythmia, without AAs, after single procedure. For non-paroxysmal AF, arrhythmia-free survival without AAs, was considerably lower (58.6% octogenarians vs. 81.2% younger patients, P = 0.023). If AAs were used, arrhythmia-free survival for paroxysmal AF increased to 90.5% and 92.1% in octogenarians and younger patients, respectively; and in non-paroxysmal AF it increased to 79.3% vs. 88.4%.ConclusionsRFCA is a safe and effective strategy to achieve normal sinus rhythm in a highly selected group of octogenarians. Paroxysmal AF ablation in octogenarians has similar clinical effectiveness as that seen in much younger patients. Non-paroxysmal AF ablation has lower, but still reasonable clinical effectiveness.