PO-02-201 OUTCOMES OF RADIOFREQUENCY ABLATION OF ATRIAL FIBRILLATION IN OCTOGENARIANS IN A MULTICENTER REGISTRY (REAL-AF)

Abstract

Catheter ablation for atrial fibrillation (AF) has significantly increased in prevalence, including in an elderly population. However, some studies suggest that outcomes of AF ablation may be inferior in elderly patients. Real-world, multi-center data is minimal and may provide more insight on this possibility. To compare the outcomes of octogenarians versus non-octogenarians undergoing catheter ablation of AF in high volume centers. Patients undergoing radiofrequency ablation of AF were prospectively enrolled in a multi-center registry (REAL-AF) from January 2018 to May 2021. The cohort was divided into 2 groups, patients ≥ 80 years old (octogenarians) and patients < 80 years old (non-octogenarians). Baseline characteristics and procedural data were collected prospectively on all patients. Routine ambulatory monitoring was performed at 6- and 12-months and additionally as needed based on symptoms. Efficacy was assessed at 12 months. The primary outcome was freedom from symptomatic atrial arrhythmias lasting greater than 30 seconds after a 90-day blanking period. 71 patients were included in the octogenarian group and 1,134 patients in the non-octogenarian group. The proportion of patients with persistent AF was similar between the groups. Octogenarians were more likely to have lower BMI, hypertension, prior bleeding, and left atrial scar as assessed by electro-anatomic mapping system (EAM). Left ventricular ejection fraction and left atrial volume as measured on EAM were also similar among the groups. There was a trend towards increased recurrence of atrial arrhythmias in octogenarians (table 1). At 12 months, octogenarians were more likely to be on anti-arrhythmic drugs as well. However, there was no difference in procedure-related complications between the groups. When controlled for left atrial scar burden, there was no difference in outcomes between the two groups. Octogenarians undergoing ablation of atrial fibrillation are more likely to have recurrent atrial arrhythmias than younger patient; this difference seems to be associated with an increased likelihood of abnormal left atrial voltage in the elderly patients. Although octogenarians are considered a frail population, AF ablation maintained similar safety profiles and arrhythmia related healthcare utilization rates when compared to a younger population.