Vnitr Lek 2013, 59(1):16-22

Outcomes of Catheter Ablation of Atrial Fibrillation in Patients over 65 Years of Age

M. Fiala^1,2,*, L. Škňouřil¹, O. Toman², J. Pindor¹, D. Wojnarová¹, V. Bulková¹, J. Chovančík¹, M. Dorda¹, H. Szymeczek¹, R. Neuwirth¹, D. Vavřík¹, Š. Krawiec¹, O. Jiravský¹, L. Rybka², R. Lábrová², J. Januška¹, J. Špinar²

¹ Oddělení kardiologie Nemocnice Podlesí, a.s., Třinec, přednosta prim. MUDr. Marian Branny

² Interní kardiologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jindřich Špinar, CSc., FESC

Purpose:
This study assessed ablation techniques, recurrent arrhythmias, long-term outcomes, and complications of catheter ablation for atrial fibrillation (AF) in patients ≥ 65 years of age.

Methods:
Consecutive patients aged < 65 years (n = 653) vs ≥ 65 years (n = 213), who underwent catheter ablation of AF in the course of eight years, were compared. Ablation strategy and procedure endpoints were left at the operator's discretion.

Results:
The group of patients ≥ 65 years comprised more females (p < 0.001), and more frequently presented with persistent AF (p = 0.010). These patients less frequently underwent simple pulmonary vein isolation (p = 0.017); on the contrary, extensive ablation including coronary sinus intervention was more common (p = 0.020). There was no difference in repeat ablation procedures (25 % vs 26 % patients; p = 0.823, or 1.4 vs 1.5 ablation procedures/1 patients; p = 0.479, respectively). Spectrum of recurrent arrhythmias did not differ between the groups except for more frequent paroxysmal AF before the first repeat ablation in patients < 65 years (p = 0.050). At the end of 49 ± 26 month total follow-up, stable sinus rhythm (SR) was achieved in 85 % patients < 65 years vs 76 % patients ≥ 65 years (p = 0.318). To maintain stable SR, older patients more often continued to take antiarrhythmic medication (p = 0.054). More serious complication occurred in 3.8 % of the patients ≥ 65 years vs 2.1 % of the patients < 65 years of age (p = 0.207).

Conclusion:
Patients ≥ 65 years of age achieved insignificantly worse long-term outcome after insignificantly fewer repeat ablation procedures, and with more frequent use of antiarrhythmic drugs. SR maintenance and risk of complications were, however, favorable.

Keywords: atrial fibrillation; catheter ablation; age; outcomes

Received: September 7, 2012; Accepted: November 22, 2012; Published: January 1, 2013  Show citation