Po-01-227 catheter ablation outcomes of atrial fibrillation in elderly and very elderly patients

Age is a non-modifiable risk factor of atrial fibrillation (AF). To assess the efficacy and safety of catheter ablation in the Elderly and Very Elderly population. All patients undergoing AF ablation (2013-2021) with available data on follow-up were analyzed. Primary endpoint was AF recurrence based on patients reported outcomes and electrocardiographic documentation. Patients were divided into 3 groups according to age at ablation; Non-Elderly (<65 years), Elderly (≥65 <75 years) and Very Elderly (≥75 years). Baseline and 1-year patient surveys were used to estimate AF severity score (AFSS) as well as AF burden (mean of AF duration score and AF frequency score; scale 0: no AF to 10: continuous with 9 frequencies/durations in between). A total of 7020 patients were included (42% Non-Elderly, 42% Elderly and 16%Very Elderly). Periprocedural major complications were low (<1%). Pericardial effusion was very uncommon but more frequent with older age (Non-Elderly 3 (0.1%); Elderly 15 (0.5); Very Elderly 6 (0.5%); p<0.05). In all patients, a direct relationship was seen between AF recurrence and increase in age. However there was an interaction between age group and AF type. At 3 years, AF recurrence after ablation for persistent atrial fibrillation (PersAF) was the highest in very elderly group (36%), followed by the Elderly group (30%) and was the lowest in the non-Elderly group (23%; lower right Figure). In paroxysmal AF (PAF), there was no difference in recurrence between Elderly and Non-Elderly, while Very Elderly remained associated with a significant increased risk (lower left Figure). Multivariate logistic regression comparing Elderly and Very Elderly to non-Elderly confirmed these findings (PersAF: Very Elderly: HR=1.44, p<0.0001, Elderly: HR=1.23, p=0.03; PAF: Very Elderly HR=1.29, p=0.017; Elderly: HR=1.04, p=0.62) (Table). Catheter ablation resulted in improvement in AFSS irrespective of age group at one year follow up (Non-Elderly:12→5., Elderly:11.5→4.5 and Very Elderly:11.5→5; p<0.001). At one year, AF duration was minimal in all groups but was the highest in the Very Elderly (7.4 vs 1.1 at 1 year) followed by Elderly (6.9 vs 0.7) and Non-Elderly (6.5 vs 0.6). Catheter ablation in Elderly and Very Elderly patients appears to be safe and efficacious. Very Elderly patients have a higher rate of AF recurrence when compared with Elderly or Non-Elderly. Nevertheless, ablation significantly improved AF burden and symptoms at one year in all age groups.Tabled 1Table - Logistic Regression Analysis Predicting AF Recurrence by Age Groups:GroupHR95% CIP valueMultivariable AnalysisAll PatientsNon-Elderly (<65 years)ReferenceElderly (≥65 <75)1.1461.03-1.270.009Very Elderly (≥75 years)1.3811.21-1.57<0.001ParoxysmalNon-Elderly (<65 years)ReferenceElderly (≥65 <75)1.040.89-1.210.62Very Elderly (≥75 years)1.2931.04-1.590.017Non-Elderly (<65 years)ReferenceElderly (≥65 <75)1.231.07-1.410.003Very Elderly (≥75 years)1.4431.22-1.70<.0001Models were adjusted for sex, age, prior ablation, prior cardioversion, prior use of antiarrhythmic drugs (AADs), prior AAD failure, use of Cryoballoon, posterior wall isolation. Open table in a new tab