Key result
AF ablation in patients ≥70 years is linked to significant symptom improvement, though less than younger patients.
Why the study?
Older patients remain underrepresented in catheter ablation studies for AF, and patient-reported outcome measures after ablation in this population are limited.
Does first-time catheter ablation for atrial fibrillation improve patient-reported symptoms and clinical outcomes similarly in patients ≥70 years compared to patients 60-65 years?
Cohort (n=344)
No
Does first-time catheter ablation for atrial fibrillation improve patient-reported symptoms and clinical outcomes similarly in patients ≥70 years compared to patients 60-65 years?
First-time catheter ablation for atrial fibrillation in patients ≥70 years yields clinically meaningful symptom improvement and comparable safety to younger patients, despite higher arrhythmia recurrence rates.
May support ablation for symptom relief in elderly AF patients; leaves open age-related efficacy differences in randomized trials.
Background and aims Older patients remain underrepresented in studies of catheter ablation (CA) for atrial fibrillation (AF), and patient-reported outcome measures (PROMs) after ablation in this population are limited. We compared real-world clinical outcomes and PROMs after first-time CA for AF in patients ≥70 years and 60–65 years. Methods All patients aged ≥70 or 60–65 years undergoing first-time CA for AF at Oslo University Hospital Rikshospitalet between 2017 and 2021 were retrospectively invited in 2022 to complete standardized questionnaires. The modified European Heart Rhythm Association (mEHRA) classification was used to grade symptoms, with change expressed as Δ mEHRA (follow-up minus baseline). Clinical and procedural data were retrieved from medical records. Results Of 462 eligible patients, 344 were included: 132 ≥ 70 years (median age 73.0, 64% male), and 212 aged 60–65 (median age 63.0, 73% male). Both groups reported significant symptom relief one year after ablation (≥70: ΔmEHRA −1.42 ± 1.29, p < 0.001; 60–65: ΔmEHRA −1.78 ± 1.17, p < 0.001), with greater absolute reduction in the younger group in unadjusted analyses ( p = 0.021). At follow-up, median mEHRA scores were low and identical between groups [1 (1–2) vs. 1 (1–2)], with a greater proportion of older patients reporting any improvement ( p = 0.034). Complication rates were not statistically significantly different (5% vs 7%, p = 0.62), whereas reported AF recurrence was higher among older patients (59% vs 47%, p = 0.042). Conclusion In this real-world cohort, patients ≥70 years undergoing first-time CA for AF experienced meaningful symptom improvement and no statistically significant difference in complication rates compared with patients aged 60–65 years, despite higher reported recurrence rates. These findings highlight the value of PROMs alongside conventional rhythm outcomes when assessing treatment benefit in older patients.
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Borch et al. (2026) conducted a cohort in Atrial fibrillation (n=344). Catheter ablation in patients ≥70 years vs. Catheter ablation in patients 60-65 years was evaluated on Change in mEHRA symptom score from baseline to one year post-ablation (p=0.021). Patients ≥70 years undergoing first-time catheter ablation for atrial fibrillation experienced significant symptom improvement (ΔmEHRA -1.42), though with a smaller absolute reduction than patients aged 60-65 years (ΔmEHRA -1.78, p=0.021).
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