Catheter ablation for atrial fibrillation in elderly patients: Systematic review and a meta‐analysis

Iwanari Kawamura; Tadao Aikawa; Yujiro Yokoyama; Hisato Takagi; Toshiki Kuno

doi:10.1111/pace.14413

November 24, 2021Pacing and Clinical Electrophysiology

Catheter ablation for atrial fibrillation in elderly patients: Systematic review and a meta‐analysis

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Why the study?

Catheter ablation is established therapy for AF, but there is limited understanding of its long-term efficacy and periprocedural safety in elderly patients.

Does catheter ablation for atrial fibrillation have similar efficacy and safety in elderly compared to non-elderly patients?

Structured PICO

Does catheter ablation for atrial fibrillation have similar efficacy and safety in elderly compared to non-elderly patients?

P

Population

110,606 patients with atrial fibrillation from 20 observational studies, including 8,009 elderly patients (7.2%)

I

Intervention

Catheter ablation (radiofrequency or cryoballoon) in elderly patients

C

Comparator

Catheter ablation in non-elderly patients

O

Outcome

Atrial fibrillation recurrence (efficacy) and procedure-related complications (safety)

Catheter ablation for atrial fibrillation in elderly patients offers comparable long-term efficacy to non-elderly patients, but carries a higher risk of procedure-related complications, particularly with radiofrequency ablation.

Implication

Higher periprocedural risks in elderly AF patients warrant individualized CA decisions; leaves open whether cryoballoon reduces complications versus radiofrequency in trials.

Abstract

Aims Catheter ablation (CA) is established therapy for patients with atrial fibrillation (AF); however, there is a limited understanding of CA in elderly patients. We studied the long‐term efficacy and periprocedural safety of radiofrequency and cryoballoon CA for elderly patients with AF. Methods PubMed and Embase were searched through April 2021 to investigate the comparative outcomes between elderly and non‐elderly patients who underwent CA for AF. The primary efficacy and safety endpoints were AF recurrence and procedure‐related complications, respectively. Subgroup analyses were performed by procedure type of CA. Results The search identified 20 observational studies with 110,606 patients, including 8009 elderly patients (7.2%). The risk of AF recurrence was not significantly different between elderly and non‐elderly patients (hazard ratio, 1.37; 95% confidence interval [CI], 0.94–2.00; p = .10, I 2 = 70%). However, relative to the non‐elderly, elderly patients had significantly higher major complications (risk ratio [RR], 1.32; 95% CI, 1.14–1.54], p < .01, I 2 = 0%) and overall complications (RR, 1.26; 95% CI, 1.00–1.57; p = .05, I 2 = 56%) with higher cerebrovascular events (RR, 1.68; 95% CI, 1.25–2.25; p = < .01, I 2 = 0%). Subgroup analysis with cryoballoon CA showed that procedure‐related complications in elderly patients were similar to those in non‐elderly patients but not with radiofrequency CA. Conclusions CA for AF in elderly patients has comparable long‐term efficacy compared to that in non‐elderly patients; however, the incidence of procedure‐related complications were higher in elderly patients. Cryoballoon CA did not confer a higher procedure‐related risk in elderly patients.