Elderly Atrial Fibrillation Patients Research Articles

Analyses of risk factors and prognosis for new-onset atrial fibrillation in elderly patients after dual-chamber pacemaker implantation.

ObjectiveTo retrospectively identify risk factors and the prognosis for new-onset atrial fibrillation (AF) after implantation of dual-chamber pacemakers in elderly patients.MethodsConsecutive patients aged ≥ 65 years who underwent their first implantation of a dual-chamber permanent pacemaker in Beijing Anzhen Hospital from October 2013 to May 2016 were enrolled. Their complete programming and follow-up data were recorded. Follow-up end points included new-onset AF and major adverse cardiovascular and cerebrovascular events.ResultsAltogether, 322 patients were enrolled, with new-onset AF observed in 79 (24.5%) during their follow-up. Multivariable analysis identified four independent predictors of new-onset AF in elderly patients after pacemaker implantation: hypertension (HR = 3.040, 95% CI: 1.09–3.05, P = 0.00); age (HR = 1.966, 95% CI: 1.57–3.68, P = 0.01); left atrial enlargement (HR = 1.645, 95% CI: 1.05–1.25, P = 0.03); high ventricular pacing rate (HR = 1.137, 95% CI: 1.01–1.06, P = 0.01). Univariable analysis indicated that the CHA2DS2-VASc score was also a risk factor for AF (HR = 1.368, 95% CI: 1.178–1.589, P = 0.002), whereas multivariable regression analysis did not. Kaplan–Meier survival analysis showed that the risk for ischemic stroke was significantly higher in the new-onset AF group than in the non-AF group (P < 0.05).ConclusionHypertension, age, left atrial enlargement, and high ventricular pacing rate were independent predictors of new-onset AF in elderly patients after implantation of a permanent pacemaker. New-onset AF increased the risk for ischemic stroke.

Frailty Status Affects the Decision for Long-Term Anticoagulation Therapy in Elderly Patients with Atrial Fibrillation.

Elderly patients are underrepresented in the studies concerning anticoagulation therapy (AT) in atrial fibrillation (AF), while patients' frailty status is lacking in most of the studies. Our objective was to evaluate AT in AF elderly patients and study the effect of patients' frailty status on their long-term AT. We conducted an observational prospective study that enrolled consecutive AF patients (≥75years) who were hospitalized in the Department of Internal Medicine of the University Hospital of Heraklion, Crete, Greece from 1 June 2015 to 1 June 2016. We recorded the AT on admission and at discharge, all-cause mortality, and hospital readmission in a follow-up period of 1year after hospital discharge. Frailty status was assessed by pre-established scores. One hundred and four consecutive patients (49% male; median age 87years) were enrolled, 78 (78.8%) of whom received AT at discharge. Patients who did not receive AT at discharge had a higher HEMORR2HAGES (Hepatic or renal disease, Ethanol abuse, Malignancy, Older age, Reduced platelet count or function, Re-bleeding, Hypertension, Anemia, Genetic factors, Excessive fall risk and Stroke) score (5.5 ± 1.15 vs. 4.79 ± 1.68; p = 0.032), a lower Katz score (2.48 ± 2.23 vs. 4.08 ± 2.25; p = 0.006), and a higher Clinical Frailty Scale score (7 ± 1.95 vs. 5.57 ± 2.05; p = 0.006). Sixty-five patients (62.5%) were readmitted to a hospital during the follow-up period. In-hospital death occurred in five patients (4.8%) and 57 patients (57.6%) died within the follow-up period. A high percentage of the elderly AF patients did not receive AT, even at discharge. Patients who did not receive AT at discharge had higher bleeding and frailty scores. In the 1-year follow-up period after hospital discharge, high all-cause mortality and a high number of hospital readmissions were recorded.

Safety and efficacy of cryoballoon ablation for the treatment of atrial fibrillation in elderly patients.

Catheter ablation (CA) is an established therapy for treatment of atrial fibrillation (AF). However, data about AF ablation using the cryoballoon (CB) in the elderly population are sparse. The aim of this single center retrospective study is to evaluate the safety and efficacy of CB ablation in patients ≥ 75years compared to patients < 75years. Fifty-five consecutive patients aged ≥ 75years (elderly group) were compared with 183 patients aged < 75years (control group). All patients underwent pulmonary vein isolation (PVI) using the second-generation CB. The mean age in the elderly group was 78 ± 2.8years and 60.8 ± 9.5 in the control group (p < 0.001). During 11.8 ± 5.4months of follow-up, single procedure success rate for the elderly and the control group was 72.8 and 76%, respectively (p = 0.37). During redo ablation (n = 40), low-voltage areas in the LA were more frequently observed in elderly patients compared to the control group [1.0 (IQR 0-2.0) segments vs 2.0 (IQR 2.0-3.0) segments, respectively, p = 0.03]. The most common complication was transient phrenic nerve palsy, which only occurred in patients < 75years (0 vs 7, p = 0.33). No severe complication such as procedure-related deaths, atrio-esophageal fistula, or cerebrovascular embolic events occurred. Our data strengthen the value of CB ablation for the treatment of AF as an effective and safe procedure in elderly patients, with similar success and complication rates when compared with a younger population.

A Real-World Observational Study of Hospitalization and Health Care Costs Among Nonvalvular Atrial Fibrillation Patients Prescribed Oral Anticoagulants in the U.S. Medicare Population.

Clinical trials have shown that direct oral anticoagulants (DOACs)-including dabigatran, rivaroxaban, apixaban, and edoxaban-are at least as effective and safe as warfarin for the risk of stroke/systemic embolism (SE) and major bleeding (MB) in patients with atrial fibrillation (AF). However, few studies have compared oral anticoagulants (OACs) among elderly patients. To compare hospitalization risks (all-cause, stroke/SE-related, and MB-related) and associated health care costs among elderly nonvalvular AF (NVAF) patients in the Medicare population who initiated warfarin, dabigatran, rivaroxaban, or apixaban. Patients (aged ≥ 65 years) initiating warfarin or DOACs (apixaban, rivaroxaban, and dabigatran) were selected from the Centers for Medicare & Medicaid Services database from January 1, 2013, to December 31, 2014. Patients initiating each OAC were matched 1:1 to apixaban patients using propensity score matching to balance demographic and clinical characteristics. Cox proportional hazards models were used to estimate the risk of hospitalization of each OAC versus apixaban. Generalized linear models and two-part models with bootstrapping were used to compare all-cause health care costs and stroke/SE- and MB-related medical costs between matched cohorts. Of the 186,132 eligible patients, 41,606 warfarin-apixaban, 30,836 dabigatran-apixaban, and 41,608 rivaroxaban-apixaban pairs were matched. The OACs were associated with a significantly higher risk of all-cause hospitalization compared with apixaban (warfarin: HR = 1.33, 95% CI = 1.27-1.38, P < 0.001; dabigatran: HR = 1.17, 95% CI = 1.11-1.23, P < 0.001; and rivaroxaban: HR = 1.27, 95% CI = 1.22-1.32, P < 0.001) and were associated with a significantly higher risk of hospitalization due to stroke/SE (warfarin: HR = 2.51, 95% CI = 1.92-3.29, P < 0.001; dabigatran: HR = 2.24, 95% CI = 1.60-3.13, P < 0.001; and rivaroxaban: HR = 1.74, 95% CI = 1.31-2.30, P < 0.001). Also, the OACs were associated with significantly higher risk of hospitalization due to MB-related conditions compared with apixaban (warfarin: HR = 1.96, 95% CI = 1.71-2.23, P < 0.001; dabigatran: HR = 1.48; 95% CI = 1.25-1.76, P < 0.001; and rivaroxaban: HR = 2.17, 95% CI = 1.91-2.48, P < 0.001). Compared with apixaban, warfarin ($3,747 vs. $3,061, P < 0.001); dabigatran ($3,230 vs. $2,951, P < 0.001); and rivaroxaban ($3,950 vs. $3,060, P < 0.001) had significantly higher all-cause total health care costs per patient per month. Patients initiating the OACs also had significantly higher stroke/SE- and MB-related medical costs compared with apixaban: warfarin (stroke/SE = $135 vs. $60, P = 0.001; MB = $537 vs. $286, P < 0.001); dabigatran (stroke/SE = $94 vs. $62, P = 0.045; MB = $373 vs. $277, P = 0.010); and rivaroxaban (stroke/SE = $91 vs. $60, P = 0.008; MB = $524 vs. $287, P < 0.001). This real-world study showed that among elderly NVAF patients in the Medicare population, apixaban was associated with significantly lower risks of all-cause, stroke/SE-related, and MB-related hospitalizations compared with warfarin, dabigatran, and rivaroxaban. Accordingly, apixaban showed significantly lower all-cause health care costs and stroke/SE- and MB-related medical costs. This study was funded by Bristol-Myers Squibb and Pfizer. Amin is an employee of the University of California, Irvine, and was a paid consultant to Bristol-Myers Squibb in connection with this study and the development of this manuscript. Keshishian and Zhang are employees of STATinMED Research, a paid consultant to Pfizer and Bristol-Myers Squibb in connection with this study and the development of this manuscript. Trocio, Dina, Mardekian, and Liu are employees of Pfizer, with ownership of stocks in Pfizer. Le, Rosenblatt, Nadkarni, and Vo are employees of Bristol-Myers Squibb. Rosenblatt and Vo have ownership of stocks in Bristol-Myers Squibb. Baser has no conflicts to disclose.

P2505Comparison of serious adverse events in very elderly Asian atrial fibrillation patients with or without anticoagulation therapy: direct oral anticoagulants vs. warfarin vs. non-anticoagulants

P2505Comparison of serious adverse events in very elderly Asian atrial fibrillation patients with or without anticoagulation therapy: direct oral anticoagulants vs. warfarin vs. non-anticoagulants

Influence of metabolic syndrome on the prognosis of atrial fibrillation treated with catheter ablation in elderly patients

Objective To assess the influence of metabolic syndrome(MS)on the success rate of catheter ablation for the treatment of atrial fibrillation(AF)in the elderly. Methods A retrospective study included a total of 221 aged patients with AF who underwent AF ablation for the first time.The patients were divided into two groups: an MS group(n=72)and a control group(without MS)(n=149). The MS group had a mean age of (67.1±5.2) years; the control group had a mean age of (68.3±5.7) years.Forty-six patients in the MS group and 105 patients in the control group experienced paroxysmal atrial fibrillation.Prognoses in two groups were compared at the end of the follow-up. Results At the end of the follow-up, the success rates of the procedure in the MS group and the control group were 37.5%(n=27)and 51.7%(n=77), respectively(χ2=3.917, P=0.049). Recurrence happened in 19 patients of the MS group and 28 patients of the control group, and they underwent a repeat ablation.The overall success rates after the last ablation in the two groups were 51.4%(n=37)and 65.8%(n=98), respectively(χ2=4.224, P=0.034). In the multivariable model adjusted for risk factors, MS(HR=1.42, 95%CI: 1.11-1.64, P=0.033)and left atrial diameter(HR=1.83, 95%CI: 1.27-3.19, P=0.017)were independent predictors for recurrence. Conclusions MS can affect the success rate of catheter ablation for AF in elderly patients and the effect remains even after the procedures are repeated Key words: Atrial fibrillation; Catheter ablation; Metabolic syndrome X

Rate-control vs rhythm-control of atrial fibrillation in elderly patients. From new, age-oriented outcomes to a more complex management strategy.

Atrial fibrillation (AF) is the most frequent arrhythmia in elderly people. Findings derived from clinical trials seem to demonstrate that a rate-control strategy of AF in aged patients improves prognosis if compared to a rhythm-control one. However, epidemiological studies concordantly show that the arrhythmia is associated to increased hospitalization and mortality rates. In last years, the proportion of patients admitted to hospital for AF has progressively increased; this trend is observed in subjects >75 and >85 years, while no change was found in younger cohorts. Importantly, in aged individuals, probably because of the loss of atrial activity, the increase of heart rate and the irregularity of RR intervals, AF begins a vicious cycle, leading from heart failure, through the compromise of functional and neurocognitive status, to overt disability, dementia and increased mortality. Evidence specifically aimed at clarifying the effects of arrhythmia management on outcomes characteristic of aged people is completely lacking. In the elderly, the question regarding the effects of a rate- or a rhythm-control strategy of AF should be considered as an aspect of a more complex strategy, addressed to reduce disability and hospitalizations, and to improve quality of life and survival.

Prospective observational study in elderly patients with non-valvular atrial fibrillation: Rationale and design of the All Nippon AF In the Elderly (ANAFIE) Registry

BackgroundAlthough anticoagulation effectively prevents stroke in patients with atrial fibrillation (AF), it has been underused in elderly AF patients for many reasons, mainly because of knowledge gaps regarding cardiovascular treatment of these populations with multiple comorbidities and poor prognosis. The objectives of the All Nippon AF In the Elderly (ANAFIE) Registry are to collect real-world information about the clinical status of patients with non-valvular AF (NVAF) aged ≥75 years, current status of anticoagulant therapy, and prognosis with/without anticoagulation to establish a database for this specific patient population that is increasing remarkably worldwide. Methods and designThe ANAFIE Registry is an observational, multicenter, prospective study of Japanese patients with NVAF aged ≥75 years that will include 30,000 patients and have the primary endpoint of composite of stroke and systemic embolism over a 2-year follow-up period. In parallel with the main study, seven sub-cohort studies will be conducted with assessments including coagulation-fibrinolysis markers, echocardiography, heart rate, hypertension, cognitive function, frailty, and medication adherence. Subgroup analyses will be performed, and stratified by renal function, HbA1c, and maximum number of drugs used. The study was started in October 2016, with a planned 2-year recruitment period. As of January 31, 2018, 33,213 patients were enrolled; the recruitment was therefore ended 8 months earlier than the original plan. ConclusionsThe ANAFIE Registry will provide a valuable database for the clinical status, management, and outcomes of mortality, stroke, systemic embolism, and hemorrhagic events with/without anticoagulation in the increasing population of elderly NVAF patients, and will identify risk factors associated with these clinical events.

Arterial stiffness and left ventricular performance in elderly patients with persistent atrial fibrillation.

The prevalence of atrial fibrillation (AF) and arterial stiffness (AS) increases with age. To evaluate if AS is correlated to longitudinal strain (LS), a marker of left ventricular (LV) function, in elderly AF patients with preserved ejection fraction (EF) undergoing external cardioversion. AS was measured using the cardio-ankle vascular index (CAVI), LS was calculated from echocardiographic data of three consecutive cardiac cycles. We enrolled 38 patients (age 76 ± 8years; men 60.5%; EF 65 ± 7%). LS and CAVI were, respectively, - 17.7 ± 3.7% and 9.7 ± 1.3. Multivariate analysis showed that LV performance was inversely related to height (p < 0.001) and to the presence of AF-related symptoms (p = 0.008). LS grew with increasing values of CAVI (p = 0.038). In elderly AF patients with preserved systolic function, LV performance is directly associated with AS. This link could influence atrium remodeling and the incidence of arrhythmia relapse.

Choice and Outcomes of Rate Control versus Rhythm Control in Elderly Patients with Atrial Fibrillation: A Report from the REPOSI Study.

Among rate-control or rhythm-control strategies, there is conflicting evidence as to which is the best management approach for non-valvular atrial fibrillation (AF) in elderly patients. We performed an ancillary analysis from the 'Registro Politerapie SIMI' study, enrolling elderly inpatients from internal medicine and geriatric wards. We considered patients enrolled from 2008 to 2014 with an AF diagnosis at admission, treated with a rate-control-only or rhythm-control-only strategy. Among 1114 patients, 241 (21.6%) were managed with observation only and 122 (11%) were managed with both the rate- and rhythm-control approaches. Of the remaining 751 patients, 626 (83.4%) were managed with a rate-control-only strategy and 125 (16.6%) were managed with a rhythm-control-only strategy. Rate-control-managed patients were older (p=0.002), had a higher Short Blessed Test (SBT; p=0.022) and a lower Barthel Index (p=0.047). Polypharmacy (p=0.001), heart failure (p=0.005) and diabetes (p=0.016) were more prevalent among these patients. Median CHA2DS2-VASc score was higher among rate-control-managed patients (p=0.001). SBT [odds ratio (OR) 0.97, 95% confidence interval (CI) 0.94-1.00, p=0.037], diabetes (OR 0.48, 95% CI 0.26-0.87, p=0.016) and polypharmacy (OR 0.58, 95% CI 0.34-0.99, p=0.045) were negatively associated with a rhythm-control strategy. At follow-up, no difference was found between rate- and rhythm-control strategies for cardiovascular (CV) and all-cause deaths (6.1 vs. 5.6%, p=0.89; and 15.9 vs. 14.1%, p=0.70, respectively). A rate-control strategy is the most widely used among elderly AF patients with multiple comorbidities and polypharmacy. No differences were evident in CV death and all-cause death at follow-up.

Predictors of new-onset atrial fibrillation in elderly patients with acute coronary syndrome undergoing percutaneous coronary intervention.

The development of atrial fibrillation (AF) during the course of acute coronary syndrome (ACS) is related to poor prognosis. Possible predictors of new-onset AF (NOAF) have not been adequately investigated in elderly patients with ACS undergoing percutaneous coronary intervention (PCI). We aimed to identify the factors associated with NOAF in such patients. A total of 308 elderly patients with ACS undergoing PCI were enrolled in the study. Patients were divided into two groups: without NOAF [254 patients, 64.6% men, age: 73.5 (69.0-79.0) years] and with NOAF [54 patients, 70.4% men, age: 75.0 (68.7-81.2) years]. Clinical, angiographic, and laboratory features including neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-high-density lipoprotein ratio (MHR) were compared between the groups. The percentages of prior myocardial infarction (MI) (20.4 vs. 5.9%) and Killip III/ IV (24.1 vs. 7.1%), NLR [4.5 (2.6-7.2) vs. 3.2 (2.0-6.0)], and MHR [19.4 (15.7-26.5) vs. 12.9 (9.9-18.5)] were higher in patients with NOAF compared to the others (p = 0.020, < 0.001, 0.030, and < 0.001, respectively). In multivariate regression analysis, prior MI (OR 4.509, 95% CI 1.679-12.106, p = 0.003) and MHR (OR 1.102, 95% CI 1.054-1.152, p < 0.001) independently predicted NOAF. In addition, Killip III/IV was found to be an independent predictor of 6-month overall mortality (HR 2.949, 95% CI 1.218-7.136, p = 0.016). Prior MI and MHR are independent predictors of NOAF in elderly patients with ACS undergoing PCI. Killip III/IV predicts 6-month overall mortality in such patients.

Quality of management of oral anticoagulation as assessed by time in therapeutic range in elderly and younger patients

In Tunisia, where new oral anticoagulants and warfarin are not available yet, acenocumarol continues to be underused in the elderly patients with atrial fibrillation (AF), mainly due to the over estimation of the bleeding risk and the difficulties to comply with treatment. The aim of the present prospective study was to investigate whether age influences the quality of anticoagulation by acenocumarol. Sixty patients having non-valvular atrial fibrillation on acenocumarol were followed up prospectively in our department of cardiology during one year. They underwent regular PT and INR measurements. Patients were divided into two groups: younger than 65 years (group 1: 40%) and older than 65 years (group 2: 60%). The thromboembolic and hemorrhagic risk were significantly higher in elderly compared to younger patients (CHA 2 DS 2 VASc score = 3.43 ± 1.18 vs. 2.09 ± 1.23 P = 0.0001; HASBLED score = 2.16 ± 0.87 vs. 1.37 ± 0.77 P = 0.001). The mean INR and the dose of acenocumarol did not differ between both groups (mean INR = 2.58 ± 0.29 in group 1 versus 2.7 ± 0.56 in group 2, P = 0.22; mean dose = 2.48 ± 0.96 mg versus 2.24 ± 0.88, P = 0.35). The mean TTR was also similar in the two groups: 56% ± 16 in the non-elderly group and 51% ± 16 in the elderly group (P =0.24). Hemorrhagic complications were similar in both groups (5% versus 8.3%; P = 0.87). Our results suggest that in elderly AF patients, oral anticoagulation with acenocumarol has similar safety and efficiency than in younger AF patients.

Effect of advanced age on plasma homocysteine levels and its association with ischemic stroke in non-valvular atrial fibrillation.

BackgroundElevated homocysteine (Hcy) has been reported to be associated with cardiovascular events in atrial fibrillation (AF) patients, while the age-related expression pattern of plasma Hcy in AF remains unknown. The study was aimed to investigate the effect of advanced age on plasma Hcy levels and its association with ischemic stroke in non-valvular AF patients.MethodsA total of 2562 consecutive patients with non-valvular AF and 535 controls were enrolled and divided into six age groups. Plasma Hcy levels were analyzed among different age groups, and the effect of advanced age on Hcy was investigated.ResultsPlasma Hcy levels did not show any difference among groups aged below 65 years, while it increased sharply in patients aged 65–74 years and aged over 75 years (15.7 ± 4.6 µmol/L, 17.1 ± 4.9 µmol/L, both P < 0.01 compared with the first four age groups). Hcy was much higher in AF patients than in controls at the same age group (all P < 0.05). The proportion of patients with hyperhomocysteinemia increased gradually with age from 32.3%, 29.2%, 31.2%, 32.4%, 45.9%, to 51.4% in six age groups. The concentration of Hcy in AF patients with ischemic stroke increased progressively with age, and was higher than those without stroke at the same age. Logistic regression analysis demonstrated that age 65–74 years [odds ratios (OR): 1.742, 95% confidence interval (CI): 1.223–2.482, P = 0.002] and age ≥ 75 years (OR: 2.637, 95% CI: 1.605–4.335, P < 0.001) were significantly independent predictors of elevated plasma Hcy levels.ConclusionsAdvanced age was significantly associated with elevated Hcy levels, which may provide a possible explanation for the progressive increase in ischemic stroke especially in elderly AF patients.

O58-3 - Concomitant Atrial Fibrillation in Elderly Patients with Decompensated Heart Failure on Admission Does Not Influence Clinical Courses

Background: Atrial fibrillation (AF) is one of the risk factors of decompensated heart failure (HF). Methods: We investigated 212 patients more than 75 years old admitted to our hospital for the treatment of HF from June 2015 to July 2016. We divided the patients into two groups based on whether they presented with complicated AF on admission or not. We compared clinical courses between the two groups. Results: The heart rate on admission and the ratio of non-ischemic etiology were significantly higher in the AF group. However, other parameters did not vary between the two groups. There was no significant difference in mortality and acute hospitalization by decompensated HF between the two groups. Conclusions: Concomitant AF in elderly patients with HF on admission did not influence clinical courses.

Catheter ablation of atrial fibrillation in elderly population.

BackgroundAlthough elderly patients have been included in published series of catheter ablation for atrial fibrillation (AF), clinical benefit and safety remain still less defined in this population. A retrospective analysis of the results of catheter ablation for AF in a large volume center focused on comparison of elderly patients with the rest of the patient cohort was conducted in this study.MethodsConsecutive patients who underwent catheter ablation for AF between January 2001 and December 2016 were analysed. A total population of 3197 patients was dichotomized by the age of 70 years (394 elderly vs. 2803 younger subjects). Patients were followed in terms of arrhythmia status and survival for a median period of 18 vs. 21 and 35 vs. 57 months, respectively.ResultsElderly patients were more frequently females (49% vs. 29%, P < 0.0001), had a history of hypertension (79% vs. 57%, P < 0.0001), diabetes (16% vs. 11%, P < 0.01), stroke (9% vs. 6%, P < 0.01), coronary/peripheral artery disease (14% vs. 8%, P < 0.0001), and CHA2DS2-VASc score (3.1 ± 1.3 vs. 1.5 ± 1.2 s, P < 0.0001). Major complications were more frequent in elderly (5.3% vs. 3.2%, P = 0.03); however, this difference was driven by vascular complications (3.6% vs. 1.9%, P = 0.04). There were comparable rates of cerebrovascular (0.3 vs. 0.3%) or nonvascular complications (1.8 vs. 1.2%). Good arrhythmia control was inferior in elderly patients as compared with the rest of the cohort, both without and with antiarrhythmic drugs: 44.2% vs. 58.2% (P < 0.0001) and 78.2 vs. 83.2% (P < 0.01), respectively. Poor arrhythmia control was associated with relative risk of all-cause mortality of 2.7 (95% CI: 1.1–6.4) in elderly patients and 1.4 (95% CI: 0.9–2.0) in younger subjects.ConclusionsCatheter ablation for AF in elderly patients is safe although somewhat less effective. Good arrhythmia control is associated with better survival, especially in elderly patients.

5721Comparison of stroke and major bleeding risk of treatment with apixaban vs. rivaroxaban and dabigatran among elderly nonvalvular atrial fibrillation patients in the United States

5721Comparison of stroke and major bleeding risk of treatment with apixaban vs. rivaroxaban and dabigatran among elderly nonvalvular atrial fibrillation patients in the United States

Treatment of Atrial Fibrillation in Elderly Patients with the Cox Maze Procedure Concurrently with Other Cardiac Operations.

BackgroundIn elderly patients who have atrial fibrillation (AF), surgical ablation of the arrhythmia during cardiac surgery may be challenging. Despite the reported advantages of ablating AF with the Cox maze procedure (CMP), the addition of the CMP may complicate other cardiac operations. We evaluated the effect of the CMP in elderly patients concurrent with other cardiac operations.MethodsFrom October 2007 to December 2015, we enrolled 27 patients aged >70 years who had AF and who underwent the CMP concurrently with other cardiac operations. The mean preoperative additive European System for Cardiac Operative Risk Evaluation score was 8±11 (high risk).ResultsOnly 1 hospital death occurred (4%). The Kaplan-Meier method showed a high 5-year cumulative survival rate (92%). At mean follow-up of 51 months, 23 patients (89%) had sinus rhythm conversion. The postoperative left atrial dimensions did not significantly differ between the 8 patients who had reduction plasty for giant left atrium (53.4±7.5 cm) and the 19 patients who did not have reduction plasty (48.7±5.7 cm).ConclusionIn patients aged >70 years, concurrent CMP may be associated with a high rate of sinus rhythm conversion without increased surgical risk, despite the added complexity of the main cardiac procedure.

P339Safety and efficacy of catheter ablation for atrial fibrillation in elderly patients

P339Safety and efficacy of catheter ablation for atrial fibrillation in elderly patients

P1424Safety and efficacy of ablation of paroxysmal atrial fibrillation in elderly patients

P1424Safety and efficacy of ablation of paroxysmal atrial fibrillation in elderly patients

Antihyperglycemic drugs use and new-onset atrial fibrillation in elderly patients.

Antihyperglycemic drugs have been linked to new-onset atrial fibrillation (NAF). However, the effect of the different classes of antihyperglycemic drugs on the development of NAF in elderly patients has not been well studied. In this study, we investigated the association between different classes of antihyperglycemic drugs and NAF in elderly patients. This was a nested case-control study performed using the database of National Health Insurance programme in Taiwan. Each participant aged 65 years and older who were NAF from 2005 to 2012 were assigned to the NAF group, whereas case was sex-, age-, diabetes duration-, index date-matched, and Charlson Comorbidity Index score-matched randomly selected participant without NAF were assigned to the non-NAF group. Multivariable logistic regression model was used for the estimation of odds ratios (ORs) and 95% confidence intervals (CIs) of NAF associated with use of different classes of antihyperglycemic agents. Nonusers served as the reference group. We identified 1958 cases and 7832 controls. The risk of NAF after adjusting for sex, age, comorbidities and concurrent medication was higher among the users of insulin than among the nonusers (OR, 1·58; 95% CI, 1·37-1·82). Patients who took dipeptidyl peptidase 4 inhibitors were at lower risk of developing NAF than the nonusers (OR, 0·65; 95% CI, 0·45-0·93). In this population, use of dipeptidyl peptidase 4 inhibitor was associated with a low risk of NAF. Insulin use was associated with a significant increase in the risk of NAF during the long-term follow-up.