Long-term outcomes of catheter ablation for atrial fibrillation in octogenarians

Abstract

Abstract Background Catheter ablation is superior to standard medical therapy in controlling atrial fibrillation (AF). There is limited data on the long-term outcomes of AF ablation in octogenarians. Purpose This study aims to rigorously evaluate the efficacy and safety of AF catheter ablation in octogenarians, compared to non-octogenarians. Methods In this retrospective, multicentre, international study in 13 centres in the United Kingdom, France, and Switzerland, the long-term outcomes of 473 consecutive octogenarian patients undergoing catheter ablation for AF were compared to 473 propensity-matched non-octogenarian controls (median age 81.3 [80.0, 83.0] vs 64.4 [56.5, 70.7] years, 54.3% vs 35.1% females; p-value for both <0.001). The primary endpoint was the recurrence of atrial arrhythmia during 365 days' follow-up after an initial blanking period of 90 days (median follow-up time 322 [153, 365] days. Results Acute success of the ablation was achieved in 97% of octogenarians. When comparing non-octogenarians vs octogenarians, there were more complications in the octogenarians group (11.4% vs 7.0%, p=0.018), with the most common adverse events being vascular complications (3.8% vs 2.7%). The median follow-up time was 322 [153, 365] days. Through day 365, 131 (27.7%) octogenarians had a recurrence of atrial arrhythmia as compared to 111 (23.5%) non-octogenarians (odds ratio 1.49; 95% confidence interval 1.16-1.92; p=0.002). In a multivariable regression model including gender, previous AF ablation, vascular disease, chronic kidney disease, CHA2DS2-VASc score, left atrial dilatation, and indwelling cardiac implantable electronic device, age above 80 remained an independent predictor of recurrence of atrial arrhythmias throughout 365 days' follow-up. Conclusion Age over 80 is associated with higher rates of recurrence of atrial arrhythmia on 365 days' follow-up post-catheter ablation for atrial fibrillation. Arrhythmia recurrence on follow-up