Key result
Atrial fibrillation catheter ablation in 84 octogenarians achieved normal sinus rhythm at discharge in 98.8% of patients, with minimal periprocedural complications.
Why the study?
Does atrial fibrillation catheter ablation safely achieve normal sinus rhythm in octogenarians?
Cohort (n=1,592)
No
Does atrial fibrillation catheter ablation safely achieve normal sinus rhythm in octogenarians?
Catheter ablation for atrial fibrillation in octogenarians is safe and effective for achieving normal sinus rhythm at discharge, though it carries a higher risk for multiple reablations compared to younger patients.
Suggests AF ablation may be feasible in octogenarians; hypothesis-generating and requires randomized trials before practice change.
OBJECTIVES: Catheter ablation for rhythm control has emerged as a successful therapeutic option for the treatment of atrial fibrillation (AF), though it has not been well studied in octogenarians. This study evaluates its safety in octogenarians in a community hospital and reviews the benefits of rhythm control. METHODS: Among 1,592 patients undergoing AF ablation, 84 octogenarian were identified. The primary outcome was normal sinus rhythm (NSR) on electrocardiogram at discharge. Secondary outcomes were periprocedural complications and markers and risks of reablation compared to younger cohorts. RESULTS: An NSR on discharge occurred in 83 patients. Three patients required pacing for symptomatic sinus bradycardia, complete heart block, and symptomatic junctional bradycardia, respectively. Reablation for recurrent AF occurred in 23 octogenarians. Using the octogenarians as reference, the relative risk (RR) of 1 reablation was not significantly different among the age groups 70-79, 60-69, and <60 years. The RR of 2 reablations was greater in the octogenarian group (RR 0.26 [95% CI 0.09-0.71, p = 0.008], 0.42 [95% CI 0.17-1.04, p = 0.06], and 0.27 [95% CI 0.1-0.75, p = 0.01], respectively). Coronary artery disease (OR 0.14, 95% CI 0.02-0.68, p = 0.026) and percutaneous coronary intervention (OR 0.13, 95% CI 0.02-0.63, p = 0.021) were markers for reablation. CONCLUSION: AF catheter ablation achieved an NSR with minimal periprocedural complications. The benefits of rhythm control should be considered in treatment.
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Hakimian et al. (2017) conducted a cohort in Atrial fibrillation (AF) (n=1,592). Catheter ablation vs. Younger patients (<80 years) was evaluated on Normal sinus rhythm (NSR) on electrocardiogram at discharge. Atrial fibrillation catheter ablation in 84 octogenarians achieved normal sinus rhythm at discharge in 98.8% of patients, with minimal periprocedural complications.
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