Clinical outcome of catheter ablation for paroxysmal atrial fibrillation in very elderly patients: a propensity score-matched analysis

Background Catheter ablation (CA) for symptomatic paroxysmal atrial fibrillation (PAF) is established and the indication of CA in elderly patients is expanding. The safety and efficacy of CA for the patients with PAF in very elderly patients over 80 years remains unclear. Methods We enrolled 2905 consecutive patients who underwent CA for PAF as first procedure from April 2014 to December 2022 and evaluated retrospectively. Pulmonary vein isolation (PVI) was performed in all patients by radiofrequency or cryoballoon CA. Patients were divided into elderly group (over 80 years) and middle-age group (under 80 years) and their baseline characteristics without age were matched according to propensity scores. We investigated outcome and predictors of the atrial tachy-arrhythmia (ATA) recurrence between the groups. Results 372 patients (186 matched pairs) were analyzed. Mean age was 82.9±2.6 years in elderly group and 68.3±8.0 years in middle-age group. Kaplan-Meier estimates revealed higher ATA recurrence rate in elderly group than middle-age group (p<0.001). Independent risk factors for recurrence were over 80 years old (adjusted HR 5.56, 95% CI 2.91-10.8; p<0.001) and LAD (adjusted HR 1.08, 95% CI 1.04-1.12; p<0.001) and female (adjusted HR 1.85, 95% CI 1.07-3.19; p=0.03). No significant difference was found in the procedure-related major complication rate between the groups (p=0.50). Conclusions ATA recurrence rate of the patients over 80 years was higher than that of under 80 years in this matched cohort, while safety of CA might be comparable regardless of age.