Investigators from The Heart Hospital, University College London, UK, have demonstrated that atrial fibrillation (AF) ablation in older patients can be achieved safely with similar complication risks.
Dr James McCready, who presented the group’s results at the Heart Rhythm Congress in Birmingham, UK, in October, said that the majority of patients with AF are elderly but most clinical trials investigating AF ablation have excluded patients above the age of 70. He added that clinical concerns remain regarding the efficacy and safety of catheter ablation in older patients.
In order to evaluate these concerns, the investigators reviewed data of all unselected AF ablation procedures done in their hospital over a four-year period and compared the outcomes of patients below and above 70 years of age. Only complete data with a minimum of six months follow-up were included. Of the total 552 AF ablation procedures, 81 (15%) were performed in patients over the age of 70 years.
Similar success rates
The results showed that overall single procedure success rates were the same for both groups (55%). According to McCready, there was a trend to inferior single procedure success rates for persistent AF in the >70 group (29% vs. 45%, p=.30) and an improved success in paroxysmal atrial fibrillation (PAF) (74% vs. 63%, p=.36). Major complication rate – which included cardiovascular accidents, haemoptysis, phrenic nerve palsy, tamponade requiring drainage, and vascular access complication requiring intervention – was similar for the two groups at 23/441 (5%) in the <70 group and 6/81 (7%) in the >70 group (p=.43).
The investigators concluded that AF ablation in older patients (>70 years old) can be achieved safely with complication risks similar to that in younger patients. “In persistent AF, there was a trend towards lower success rates in patients >70 years old. An ablation strategy can be offered to these patients after risk and benefit assessment according to symptoms and other comorbidity,” concluded McCready.